Impact of percutaneous transhepatic biliary drainage via different routes under CT guidance on obstructive jaundice

To compare the postoperative biochemical recovery and complications of computed tomography (CT)-guided Percutaneous Transhepatic Biliary Drainage (PTBD) via left-lobe versus right-lobe approaches for malignant obstructive jaundice. In this single-center retrospective study, 254 patients were categorized into two groups based on the hepatic access route: the Left-Lobe Group (puncture via segments S2/S3, n = 136) and the Right-Lobe Group (puncture via segments S5/S6 or conventional right pathways, n = 118). The comparison encompassed technical success, procedure-related parameters (number of puncture attempts, fluoroscopy time, total procedure time, radiation dose), postoperative recovery (hospital stay, duration of pain), serial liver function tests (total bilirubin, direct bilirubin, alanine aminotransferase [ALT], aspartate aminotransferase [AST], alkaline phosphatase [ALP], gamma-glutamyl transpeptidase [GGT]) preoperatively and on days 3 and 7, and the incidence of procedure-related complications. Technical success was defined as successful placement of the drainage catheter into the target bile duct, confirmed by post-procedural cholangiography and established bile drainage. The Left-Lobe Group demonstrated a significantly higher technical success rate (89.71 % vs. 77.12 %, P = 0.007), corresponding to an absolute risk difference of 12.6 % (95 % CI: 3.5 %–21.7 %). Postoperatively, this group showed superior recovery: lower AST at 3 days (P = 0.019), lower direct bilirubin at 7 days (P < 0.001), greater decline rates in ALP (P = 0.003) and GGT (P = 0.003) at 7 days. Complication rates were also significantly lower for bile leak (5.88 % vs. 15.25 %, P = 0.014), catheter occlusion (2.94 % vs. 11.02 %, P = 0.010), and pleural effusion (0.74 % vs. 7.63 %, P = 0.013). No major complications (severe hemorrhage requiring intervention or procedure-related mortality) occurred in either group. The left-lobe approach for CT-guided PTBD may be associated with higher technical success, more effective and rapid improvement in liver function, and suggests a lower rate of specific minor complications compared to the right-lobe approach.