A) PERCUTANEOUS TRANSHEPATIC BILIARY DRAINAGE ( PTBD )
It is indicated in cases where the outflow of bile from the liver into the intestines is obstructed. The obstruction can be caused due to stones or tumor or enlarged lymph nodes. The patients typically present themselves with yellowish discolouration of skin, urine and eyes. It is a highly effective procedure to establish drainage for the bile from the liver, thereby providing relief to the patient.
The procedure involves puncturing the dilated bile channels through the skin and placement of a drainage tube in the biliary system, thereby creating an alternative channel for drainage of the bile. Plastic or metallic stent can be placed through the obstruction to keep the outflow tract open to allow free drainage of bile. It is a safe and cost-effective day care procedure in which the patient is discharged on the same day.
B) TRANSJUGULAR LIVER BIOPSY ( TLB )
This procedure is indicated for taking a tissue sample from the liver to establish cause and effect of liver disease. It is indicated in patients where tissue sample cannot be taken by the normal method of direct puncture through the skin due to uncorrectable blood thinning, massive ascites (fluid in the abdomen), morbid obesity or shrunken liver.
In this procedure, biopsy of the liver is taken from within the body (inside out approach). The liver is accessed through a small puncture in the vein of the neck. The chances of life threatening complications are reduced drastically. The patient needs to stay overnight in the hospital.
C) TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT ( TIPS )
This procedure establishes an alternative channel of blood flow within the liver. TIPS is most commonly performed for prevention of recurrent gastroesophagealvariceal haemorrhage ( bleeding from the mouth in patients with liver disease) or refractory ascites ( fluid in the abdomen) in patients with severe portal hypertension as these conditions cannot be managed by endoscopic methods successfully. It is also been used as ”bridge” to liver transplant.