Effect of preoperative biliary drainage on surgical outcome after pancreatoduodenectomy.
BACKGROUND
The role of preoperative biliary drainage in patients with biliary obstruction undergoing pancreatoduodenectomy remains controversial. Several authors failed to show any effect of preoperative biliary drainage, whereas others even reported an increased morbidity following pancreatoduodenectomy.


METHODS
Retrospective analysis was performed in a consecutive series of 257 patients undergoing pancreatoduodenectomy between November 1993 and November 1999.


RESULTS
Ninety-nine patients (38%) underwent preoperative biliary drainage for a median time period of 10 days (range 1 to 41) prior to resection. Cumulative postoperative morbidity was 47% (120 patients), the reoperation rate was 4.3% (11 patients), and mortality was 2.3% (6 patients). There was no difference in total morbidity, infectious complications, reoperation rate, mortality, or long-term survival between patients with or without preoperative biliary drainage.


CONCLUSIONS
Preoperative biliary instrumentation and biliary drainage do not affect early or late outcome in patients undergoing pancreatoduodenectomy.
Department of Visceral and Transplantation Surgery, University of Bern, Inselspital, CH-3010, Bern, Switzerland. markus.buechler@insel.ch
M E
ME
Martignoni
M
M
Wagner
L
L
Krähenbühl
C A
CA
Redaelli
H
H
Friess
M W
MW
Büchler
D000368:Aged; D016022:Case-Control Studies; D001651:Cholestasis, Extrahepatic / Q000628:therapy*; D003137:Common Bile Duct Diseases / Q000628:therapy*; D004322:Drainage / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D010190:Pancreatic Neoplasms / Q000601:surgery; D016577:Pancreaticoduodenectomy; D011182:Postoperative Care; D011183:Postoperative Complications / Q000453:epidemiology; D011300:Preoperative Care; D012189:Retrospective Studies; D016896:Treatment Outcome