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The mortality rates of surgery and percutaneous transhepaticbiliary drainage (PTHBD) are comparable. Long tenn studies show that delayedcomplications occur in the majority of cases of PTHBD and survival is notimproved compared to surgery. The many recent advances in endoscopic andpercutaneous drainage techniques and the recognition that the patient is bestserved by a noncompetitive multidisciplinary approach will ensure that virtuallyevery patient obtains the most satisfactory drainage possible with a minimum ofrisk and discomfort. Endoscopic drainage should be the first therapeutic option,with radiologic assistance in the 15 to 25% where endoscopic drainage fails or is incomplete

Percutaneous Biliary Drainage with Emphasis on Hilar Lesions