What to Expect During a Biliary Intervention
These procedures usually is done on an outpatient basis, however, some procedures may require admission. Please consult with your doctor.
You may have an ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) prior to your biliary intervention.
You may be given medications to help prevent nausea and pain, and antibiotics to help prevent infection.
You will be positioned on the exam table.
You will be connected to monitors that track your heart rate, blood pressure and pulse during the procedure.
A nurse or technologist will insert an I.V. into a vein in your hand or arm so that sedative medication can be given intravenously. You also may receive general anesthesia.
Percutaneous Transhepatic Cholangiography (PTC)
The area of your body where the needle or laparoscope is to be inserted will be shaved, sterilized and covered with a surgical drape.
A very small nick is made in the skin at the site.
A thin needle is inserted through the skin below the ribs and into the liver using X-ray (fluoroscopy) guidance. A contrast material is injected into your liver and bile ducts, and X-rays are taken. If a blockage is found, a catheter may be temporarily left in the liver to drain bile into the small intestine or a collection bag outside the body.
Using image-guidance, a stent may be placed in a narrow portion of a bile duct to help keep the duct open. A balloon-tipped catheter may be used to help expand a narrow duct.
Stents can be self-expandable (opens up itself upon deployment) or balloon expandable (balloon needed to open the stent). Balloon expandable stents are typically placed over a balloon-tipped catheter so that when the balloon is expanded, it pushes the stent in place against the duct wall. When the balloon is deflated and removed, the stent remains in place, acting like a scaffold for the duct.
If imaging reveals a gallstone in the common bile duct (CBD), the doctor may make a small incision in the bile duct and remove the stone(s).
Your intravenous line will be removed.
You will feel a slight prick when the needle is inserted into your vein for the I.V. and when the local anesthetic is injected.
If you receive a general anesthetic, you will be unconscious for the entire procedure, and you will be monitored by an anesthesiologist.
The I.V. sedative will make you feel relaxed and sleepy. You may or may not remain awake, depending on how deeply you are sedated.
As the contrast material passes through your body, you may get a warm feeling.
You will remain in the recovery room until you are completely awake and ready to return home.
In general, for all of these procedures, you should be able to resume your normal activities within a few days. In some cases, you may have a catheter exiting your side and draining bile into a bag. The duration of the drainage into a bag will vary from patient to patient. Consult your interventional radiologist for information about your treatment.
Limitations of Biliary Interventions
Minimally invasive procedures such as biliary interventions may not be appropriate for all patients. The decision as to whether your specific situation can be treated with these techniques will be made by your doctor and interventional radiologist. As a general rule, minimally invasive procedures are preferable to open surgery but there are instances in which a minimally invasive procedure would not be appropriate. In general, if this were the case, open surgery would be the procedure of choice.
In some cases, a recurrence of the underlying problem such as blockage of a stent or cholecystitis may occur. In these cases, repeat biliary intervention may be necessary. If this were not felt to be appropriate, open surgery could be performed.