title: Effect of preoperative biliary stenting on immediate outcome after pancreaticoduodenectomy.
abstract: BACKGROUND
  Preoperative biliary stenting is associated with bacterial contamination of bile and an increased rate of infectious complications after pancreaticoduodenectomy. Preoperative drainage has been found to have conflicting effects on morbidity and mortality, and no studies have been published on the effect of stent complications and duration of stenting on postoperative outcome. This study examined the effects of preoperative biliary stenting on early outcome after pancreaticoduodenectomy.
  
  
  METHODS
  Details of 144 patients undergoing pancreaticoduodenectomy from 1992 to 2001 were entered into a database. Variables included biliary stenting, duration of stenting, stent complications and bile culture results. Details of surgery and postoperative complications were noted. Patients were grouped as stented and non-stented. Factors likely to affect postoperative mortality and morbidity were analysed.
  
  
  RESULTS
  Preoperative biliary stenting was performed in 74 of the 144 patients; post-stenting complications developed in 18 patients (24 per cent) before surgery. After surgery there were nine deaths (6.3 per cent) and 60 (41.7 per cent) of the 144 patients developed complications, with no significant difference in morbidity rate between stented and non-stented patients. Logistic regression showed that a positive intraoperative bile culture was the only factor significantly associated with operative morbidity (P < 0.001) and mortality (P = 0.019). Biliary stenting was not significantly associated with a positive culture (P = 0.073), but stenting that resulted in complications (P = 0.006) and drainage for less than 6 weeks (P = 0.011) was associated with significantly greater culture positivity. Stenting followed by complications was shown by logistic regression to be the only factor significantly associated with a positive culture (P = 0.012).
  
  
  CONCLUSIONS
  A positive intraoperative bile culture was associated with higher morbidity and mortality rates following pancreaticoduodenectomy. A positive culture in the stented group was related to stent complications and duration of stenting. Uncomplicated stenting was not associated with increased morbidity or mortality.
authors.affiliation: Department of Surgical Oncology, Lilavati Hospital and Research Centre, Mumbai, India. jagannath@vsnl.com
authors.forename: P
authors.initials: P
authors.lastname: Jagannath
authors.forename: V
authors.initials: V
authors.lastname: Dhir
authors.forename: S
authors.initials: S
authors.lastname: Shrikhande
authors.forename: R C
authors.initials: RC
authors.lastname: Shah
authors.forename: P
authors.initials: P
authors.lastname: Mullerpatan
authors.forename: K M
authors.initials: KM
authors.lastname: Mohandas
mesh_terms: D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods; D015331:Cohort Studies; D004322:Drainage / Q000379:methods*; D004379:Duodenal Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality*; D011300:Preoperative Care / Q000379:methods*; D015607:Stents; D016896:Treatment Outcome