Effect of preoperative endoscopic biliary drainage on infectious morbidity after pancreatoduodenectomy: a case-control study.
BACKGROUND
The utility of preoperative endoscopic biliary drainage (PEBD) in jaundiced patients before pancreatoduodenectomy (PD) is still debated. This is in part due to the heterogeneity of the studied population, including different tumor location, drainage techniques, and surgical procedures. The aim of the current study was to report the influence of PEBD on postoperative infectious morbidity of PD.


METHODS
Between January 1996 and December 2004, 124 patients underwent a PD and 28. Twenty-eight (22.6%) of these patients underwent a PEBD. This group of patients was matched to 28 control patients who underwent PD without PEBD during the same period. The 2 groups were matched for age, sex, indication of surgery, and serum bilirubin levels.


RESULTS
The specific morbidity of PEBD before surgery was 10.7% (n = 3). The postoperative overall morbidity, medical morbidity, and surgical morbidity rates were not different between the 2 groups. At the time of surgery, 89.3% (n = 25) of the patients in the PEBD group had positive bile culture in comparison to 19.4% (n = 4) in the control group (P < .001). The number of patients with 1 or more infectious complications was higher in the PEBD group (50%; n = 14) than in the control group (21.4%; n = 6) (P = .05).


CONCLUSIONS
Before PD, PEBD should be routinely avoided whenever possible in patients with potentially resectable pancreatic and peripancreatic lesions. In patients with cholangitis, requiring extensive preoperative assessment (such as liver biopsy) or neoadjuvant treatment, PEBD might still be indicated.
Lermite
Emilie
E
Service de Chirurgie Digestive, CHU Angers, 4 Rue Larrey, 49933 Angers cedex 9, France.
Pessaux
Patrick
P
Teyssedou
Carlos
C
Etienne
Sandrine
S
Brehant
Olivier
O
Arnaud
Jean-Pierre
JP
D000368:Aged; D016063:Blood Loss, Surgical; D016022:Case-Control Studies; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D004322:Drainage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000401:mortality; D010195:Pancreatitis / Q000209:etiology / Q000517:prevention & control; D010343:Patient Admission; D011014:Pneumonia / Q000209:etiology / Q000517:prevention & control; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology* / Q000382:microbiology / Q000401:mortality / Q000517:prevention & control*; D011300:Preoperative Care / Q000009:adverse effects* / Q000379:methods*; D018805:Sepsis / Q000209:etiology / Q000517:prevention & control; D013530:Surgical Wound Infection / Q000209:etiology / Q000517:prevention & control; D014552:Urinary Tract Infections / Q000209:etiology / Q000517:prevention & control