title: Preoperative bile salt administration versus bile refeeding in obstructive jaundice.
abstract: BACKGROUND
  Endotoxaemia due to intraluminal bile salt depletion may be a cause of renal failure in patients with obstructive jaundice. Administration of bile salts to these patients has been reported to decrease portal and systemic endotoxaemia during surgery and improve renal function. However, such changes have not been shown with bile refeeding. We compared the effect of preoperative bile salt administration with preoperative bile refeeding on renal function in patients with obstructive jaundice.
  
  
  METHODS
  Sixteen patients with obstructive jaundice underwent percutaneous transhepatic biliary drainage--eight received oral bile salts (500 mg of sodium deoxycholate 8-hourly for 48 hours preoperatively) and the other 8 were refed the total bile output for the entire period of biliary drainage (median 13 days). Blood endotoxin levels and renal function were assessed before, during and after the operation.
  
  
  RESULTS
  The number of patients with intraoperative portal and postoperative systemic endotoxaemia decreased after both forms of therapy. Renal function also improved in both the groups--all 4 patients with renal failure recovered. There was a significant increase in creatinine clearance postoperatively after bile salt therapy (from 65 ml/minute preoperatively to 87 ml/minute postoperatively).
  
  
  CONCLUSIONS
  Refeeding of bile obtained by percutaneous catheter drainage is an effective, cost-free substitute for oral bile salts in patients with obstructive jaundice.
authors.affiliation: Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: U
authors.initials: U
authors.lastname: Tripathy
authors.forename: R K
authors.initials: RK
authors.lastname: Dhiman
authors.forename: A
authors.initials: A
authors.lastname: Attari
authors.forename: R N
authors.initials: RN
authors.lastname: Katariya
authors.forename: N K
authors.initials: NK
authors.lastname: Ganguly
authors.forename: Y K
authors.initials: YK
authors.lastname: Chawla
authors.forename: J B
authors.initials: JB
authors.lastname: Dilawari
mesh_terms: D000328:Adult; D001646:Bile / Q000502:physiology*; D001647:Bile Acids and Salts / Q000627:therapeutic use*; D002779:Cholestasis / Q000503:physiopathology / Q000628:therapy*; D004731:Endotoxins / Q000097:blood; D005260:Female; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D008297:Male; D008875:Middle Aged
chemical_list: D001647:Bile Acids and Salts; D004731:Endotoxins