<p>This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</p> <p>Percutaneous Transhepatic Biliary Drainage (PTBD) is performed in surgical jaundice to
decompress the biliary tree and improve hepatic functions. However, the risk of sepsis is high
in these patients due to immunosuppression and surgical outcome remains poor. This raises a
question—can we do away with PTBD? To answer this query a study was carried out in 4
groups of patients bearing in mind the high incidence of sepsis and our earlier studies, which
have demonstrated immunotherapeutic potential of Tinospora cordifolia (TC): (A) those
undergoing surgery without PTBD (n = 14), (B) those undergoing surgery after PTBD
(n = 13). The mortality was 57.14% in Group A as compared to 61.54% in Group B. Serial
estimations of bilirubin levels carried out during the course of drainage (3 Wks) revealed a
gradual and significant decrease from 12.52 ± 8.3 mg% to 5.85 ± 3.0 mg%. Antipyrine half-life
did not change significantly (18.35 ± 4.2 hrs compared to basal values 21.96 ± 3.78 hrs). The
phagocytic and intracellular killing (ICK) capacities of PMN remained suppressed (Basal:
22.13 ± 3.68% phago, and 19.1 ± 4.49% ICK; Post drainage: 20 ± 8.48% Phago and 11.15 ± 3.05% ICK). Thus PTBD did not improve the metabolic capacity ofthe liver and mortality was
higher due to sepsis. Group (C) patientg received TC during PTBD (n = 16) and Group (D)
patients received TC without PTBD (n = 14). A significant improvement in PMN functions
occurred by 3 weeks in both groups (30.29 ± 4.68% phago, 30 ± 4.84% ICK in Group C and
30.4 ± 2.99% phago, 27.15 ± 6.19% ICK in Group D). The mortality in Groups C and D was
25% and 14.2% respectively during the preoperative period. There was no mortality after
surgery. It appears from this study that host defenses as reflected by PMN functions play an
important role in influencing prognosis. Further decompression of the biliary tree by PTBD
seems unwarranted.</p>
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HPB Surg. 1995; 9(1):5-11