Effect of preoperative biliary drainage on surgical outcome after pancreaticoduodenectomy.
OBJECTIVE
Preoperative biliary drainage (PBD) in jaundiced patients undergoing pancreaticoduodenectomy remains controversial.


METHODS
Retrospective analysis of 313 patients undergoing pancreaticoduodenectomy between 1991 and 2004 was performed. Patients were stratified into PBD and no preoperative biliary drainage (NPBD) groups. Perioperative morbidity and mortality were evaluated and surgical risks compared. Nine retrospective studies were also evaluated.


RESULTS
PBD was performed in 210; 103 had NPBD. Common indications for PBD were jaundice and cholangitis. Postoperative complications occurred in 153; 20 died postoperatively. PBD patients were older and predominantly male. Cholangitis, low albumin, and higher preoperative bilirubin were increased in PBD. Pancreatic leakage and postoperative hospital days were increased in NPBD. Wound infection occurred more frequently in PBD, but this was not significant. Perioperative mortality rate was 6.7% in PBD compared to 5.8% in NPBD. Postoperative complication rate was 45.7% for PBD and 55.3% for NPBD. Twelve PBD patients had procedure-related complications. Of 2391 patients pooled from the nine reviews and our study (1516 PBD and 875 NPBD), no significant difference was observed in postoperative mortality and overall complications. Wound infection was significantly increased in PBD (p<0.001).


CONCLUSIONS
Preoperative biliary drainage did not increase postoperative morbidity and mortality rate in pancreaticoduodenectomy patients, but should be used judiciously.
Tsai
Yi-Fang
YF
Department of Surgery, Division of General Surgery, Taipei Veterans General Hospital, Taiwan.
Shyu
Jia-Fwu
JF
Chen
Tien-Hua
TH
Shyr
Yi-Ming
YM
Su
Cheng-Hsi
CH
D000368:Aged; D002761:Cholangitis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D003138:Common Bile Duct Neoplasms / Q000150:complications*; D004322:Drainage; D005260:Female; D006801:Humans; D041781:Jaundice, Obstructive / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome