title: Meta-analysis of randomized clinical trials on safety and efficacy of biliary drainage before surgery for obstructive jaundice.
abstract: BACKGROUND
  This meta-analysis aimed to investigate whether preoperative biliary drainage (PBD) is beneficial to patients with obstructive jaundice.
  
  
  METHODS
  Data from randomized clinical trials related to safety and effectiveness of PBD versus no PBD were extracted by two independent reviewers. Risk ratios, rate ratios or mean differences were calculated with 95 per cent confidence intervals (c.i.), based on intention-to-treat analysis, whenever possible.
  
  
  RESULTS
  Six trials (four using percutaneous transhepatic biliary drainage and two using endoscopic sphincterotomy) including 520 patients with malignant or benign obstructive jaundice comparing PBD (265 patients) with no PBD (255) were included in this review. All trials had a high risk of bias. There was no significant difference in mortality (risk ratio 1.12, 95 per cent c.i. 0.73 to 1.71; P = 0.60) between the two groups. Overall serious morbidity (grade III or IV, Clavien-Dindo classification) was higher in the PBD group (599 complications per 1000 patients) than in the direct surgery group (361 complications per 1000 patients) (rate ratio 1.66, 95 per cent c.i. 1.28 to 2.16; P < 0.001). Quality of life was not reported in any of the trials. There was no significant difference in length of hospital stay between the two groups: mean difference 4.87 (95 per cent c.i. -1.28 to 11.02) days (P = 0.12).
  
  
  CONCLUSIONS
  PBD in patients undergoing surgery for obstructive jaundice is associated with similar mortality but increased serious morbidity compared with no PBD. Therefore, PBD should not be used routinely.
authors.affiliation: Department of Neurosurgery.
authors.forename: Y
authors.initials: Y
authors.lastname: Fang
authors.forename: K S
authors.initials: KS
authors.lastname: Gurusamy
authors.forename: Q
authors.initials: Q
authors.lastname: Wang
authors.forename: B R
authors.initials: BR
authors.lastname: Davidson
authors.forename: H
authors.initials: H
authors.lastname: Lin
authors.forename: X
authors.initials: X
authors.lastname: Xie
authors.forename: C
authors.initials: C
authors.lastname: Wang
mesh_terms: D001662:Biliary Tract Surgical Procedures / Q000379:methods / Q000401:mortality; D004322:Drainage / Q000379:methods* / Q000401:mortality; D006801:Humans; D041781:Jaundice, Obstructive / Q000401:mortality / Q000601:surgery*; D007902:Length of Stay; D061214:Patient Safety; D011183:Postoperative Complications / Q000401:mortality / Q000517:prevention & control; D011300:Preoperative Care / Q000379:methods* / Q000401:mortality; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D016717:Sphincterotomy, Endoscopic / Q000379:methods / Q000401:mortality; D016896:Treatment Outcome