The effect of preoperative biliary drainage on postoperative complications after pancreaticoduodenectomy.
BACKGROUND
The benefit of preoperative biliary drainage in jaundiced patients undergoing pancreaticoduodenectomy for a suspected malignancy of the periampullary region is still under debate. This study evaluated preoperative biliary drainage in relation to postoperative outcomes.


METHODS
At the Academic Medical Center, Amsterdam, the Netherlands, a cohort of 311 patients undergoing pancreaticoduodenectomy from June 1992 up to and including December 1999 was studied. Of this cohort 21 patients with external or surgical biliary drainage were excluded and 232 patients who had received preoperative internal biliary drainage were divided into three groups corresponding with severity of jaundice according to preoperative plasma bilirubin levels: < 40 microM (n = 177), 40 to 100 microM (n = 32), and > 100 microM (n = 23) were designated as groups 1, 2, and 3, respectively. These groups were compared with patients who underwent immediate surgery (n = 58) without preoperative drainage.


RESULTS
The median number of stent (re)placements was 2 (range 1 to 6) with a median drainage duration of 41 days (range 2 to 182 days) and a stent dysfunction rate of 33%. Although patients in group 1 were better drained than patients in groups 2 and 3 (median reduction of bilirubin levels 82%, 57%, and 37%, respectively, p < 0.01), there was no difference in overall morbidity among the drained groups (50%, 50%, and 52%, respectively). There was no significant difference in overall morbidity between patients with and without preoperative biliary drainage (50% and 55%, respectively).


CONCLUSIONS
Preoperative biliary drainage did not influence the incidence of postoperative complications, and although it can be performed safely in jaundiced patients it should not be used routinely.
Sewnath
M E
ME
Department of Surgery, Academic Medical Center Amsterdam, University of Amsterdam, The Netherlands.
Birjmohun
R S
RS
Rauws
E A
EA
Huibregtse
K
K
Obertop
H
H
Gouma
D J
DJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001663:Bilirubin / Q000097:blood; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000295:instrumentation / Q000379:methods*; D003138:Common Bile Duct Neoplasms / Q000150:complications* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D004322:Drainage / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D007565:Jaundice / Q000097:blood / Q000145:classification / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000150:complications* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D012720:Severity of Illness Index; D016717:Sphincterotomy, Endoscopic / Q000295:instrumentation / Q000379:methods*; D015607:Stents / Q000009:adverse effects; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
D001663:Bilirubin