SELECTIVE PERCUTANEOUS TRANSHEPATIC LEFT-CHOLANGIOGRAPHY

Abstract

In this study, we have described a simple and safe method of inserting a needle into the left hepatic duct and our experience of this method in 217 patients with obstructive and non-obstructive jaundice.
Technique: The 7th or 8th intercostal space was used for the puncture site to avoid injuries of the diaphragmatic cornu and the height for the puncture site was midaxillar line under X-ray television control. The angle for insertion of the needle is 15 degrees to the anterior ventral wall towards horizontal line. The landmark was made on the midpoint between the just above the apex of the duodenal bulb being received 5 grams of effervesscent granules orally just before the procedure and intersection of the right diaphragm and vertebra on the right paravertebral line. The puncture needle was inserted towards the landmark untill the tip reached the depth of the vertebral center.
Results: 217 cases of the left hepatic canulations were successful in 212 patients with obstructive and non-obstructive jaundice.
A simple approach to left hepatic duct for percutaneous transhepatic cholangiography is described. The success canulation of left hepatic duct was 97.7 percent. The method described here is a simple and accurate procedure which can be used in any hospital.