DOI: https://doi.org/10.36347/sjams.2026.v14i05.002

Pages: 653-660

Percutaneous transhepatic biliary drainage (PTBD) remains an essential procedure for decompressing biliary obstruction, especially when endoscopic retrograde cholangiopancreatography is not feasible. Although both right and left hepatic approaches are routinely employed, variations in biliary anatomy, access route, and operator preference influence procedural success and safety. This systematic review aimed to compare outcomes and complication profiles between right- and left-sided PTBD. A comprehensive literature search was conducted in PubMed, Scopus, Web of Science, ScienceDirect, and JSTOR from inception to October 2025 in accordance with PRISMA 2020 guidelines. Eligible studies directly comparing right and left hepatic PTBD in adults were included. Extracted outcomes comprised technical and clinical success, complication rates, reintervention, and mortality. Study quality was evaluated across key bias domains including selection, performance, detection, reporting, and confounding risk. Six studies (n = 1,457) were included, encompassing one randomized controlled trial, four retrospective cohorts, and one abstract-only report. Technical success ranged from 80% to 100%, and clinical success from 75% to 95%, with no statistically significant differences between approaches. Most complications were minor—such as cholangitis, catheter blockage, and bile leakage. The left hepatic approach demonstrated a modest advantage for external drainage and reduced pleural complications, while the right approach favored internal–external drainage but exhibited higher rates of cholangitis in certain series. Outcomes were strongly influenced by segmental access (e.g., Couinaud segments 2/3 vs 7/8) rather than laterality alone. Overall, both hepatic approaches are safe and effective for PTBD, with comparable efficacy. Segmental entry choice and operator experience appear to be the principal determinants of success. Future standardized, prospective studies are needed to refine segmen