title: Preoperative biliary drainage, colonisation of bile and postoperative complications in patients with tumours of the pancreatic head: a retrospective analysis of 241 consecutive patients.
abstract: OBJECTIVE
  To analyse the outcome of preoperative biliary drainage in patients being operated on for a tumour in the pancreatic head.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  University hospital, The Netherlands.
  
  
  METHODS
  Consecutive series of 241 patients.
  
  
  METHODS
  Decline in bilirubin concentrations and bacterial contamination of bile as a result of preoperative drainage. Incidence of postoperative complications in patients who underwent preoperative drainage and those who did not.
  
  
  RESULTS
  184/241 patients underwent preoperative biliary drainage. Endoscopic drainage was the most effective, shown by a median reduction in bilirubin concentrations of 82%, 74%, and 50% after endoscopic drainage (n = 149), papillotomy (n = 25) and external drainage (n = 10), respectively. Bacterial contamination of bile was significantly more common when an endoprosthesis was used, but did not result in a higher rate of infective complications. 163 Whipple's resections, 33 total pancreatectomies, and 45 biliary-enteric bypasses were performed. 137/241 (57%) patients had postoperative complications. There was no significant difference in the incidence of postoperative complications between patients who had preoperative biliary drainage and those who did not (p = 0.4).
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: T M
authors.initials: TM
authors.lastname: Karsten
authors.forename: J H
authors.initials: JH
authors.lastname: Allema
authors.forename: M
authors.initials: M
authors.lastname: Reinders
authors.forename: T M
authors.initials: TM
authors.lastname: van Gulik
authors.forename: L T
authors.initials: LT
authors.lastname: de Wit
authors.forename: P C
authors.initials: PC
authors.lastname: Verbeek
authors.forename: K
authors.initials: K
authors.lastname: Huibregtse
authors.forename: G N
authors.initials: GN
authors.lastname: Tytgat
authors.forename: D J
authors.initials: DJ
authors.lastname: Gouma
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001646:Bile / Q000382:microbiology; D001663:Bilirubin / Q000097:blood; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002779:Cholestasis / Q000150:complications / Q000601:surgery; D004322:Drainage; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000150:complications / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D011183:Postoperative Complications / Q000517:prevention & control*; D011300:Preoperative Care; D012189:Retrospective Studies
chemical_list: D001663:Bilirubin