Abstract
The mortality rates of surgery and percutaneous transhepatic biliary drainage (PTHBD) are comparable. Long tenn studies show that delayed complications occur in the majority of cases of PTHBD and survival is not improved compared to surgery. The many recent advances in endoscopic and percutaneous drainage techniques and the recognition that the patient is best served by a noncompetitive multidisciplinary approach will ensure that virtually every patient obtains the most satisfactory drainage possible with a minimum of risk 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.