title: Preoperative biliary drainage of severely jaundiced patients increases morbidity of pancreaticoduodenectomy: results of a case-control study.
abstract: BACKGROUND
  Recent studies have indicated that preoperative biliary drainage (PBD) should not be routinely performed in patients suffering from obstructive jaundice before surgery. The severity of jaundice that mandates PBD has yet to be defined. Our aim was to investigate whether PBD is truly justified in severely jaundiced patients before pancreaticoduodenectomy. The parameters evaluated were overall morbidity, length of hospital stay, and total in-hospital mortality.
  
  
  METHODS
  From January 2000 to December 2012, a total of 240 patients underwent pancreaticoduodenectomy for periampullary tumors. Group A comprised 76 patients with preoperative serum bilirubin ≥15 mg/dl who did not undergo PBD before surgery. Group B comprised another 76 patients, matched for age and tumor localization (papillary vs. pancreatic head) who underwent PBD 2-4 weeks before pancreaticoduodenectomy and were identified from the same database.
  
  
  RESULTS
  Less operative time was required in the 'no PBD' group compared with the 'PBD' group (210 vs. 240 min). Total intraoperative blood loss and blood transfusions were also significantly less in the 'no PBD' group. There was no difference detected in the rate of pancreatic fistula or biliary fistula formation. Group A patients demonstrated significantly lower morbidity than group B (24 vs. 36 %, respectively) and therefore required briefer hospitalization (11 vs. 16 days). Mild infectious complications appear to be the main factor that enhanced morbidity in the PBD group. However, total in-hospital mortality was not significantly different between the two groups.
  
  
  CONCLUSIONS
  Even severe jaundice should not be considered as an indication for PBD before pancreaticoduodenectomy, as PBD increases infections and postoperative morbidity, therefore delaying definite treatment.
authors: 4th Department of Surgery, University of Athens Medical School, Attikon Hospital, 1 Rimini Str, Chaidari, 12462, Athens, Greece.
authors: Nikolaos
authors: N
authors: Arkadopoulos
authors: Maria A
authors: MA
authors: Kyriazi
authors: Ioannis S
authors: IS
authors: Papanikolaou
authors: Pantelis
authors: P
authors: Vasiliou
authors: Kassiani
authors: K
authors: Theodoraki
authors: Christos
authors: C
authors: Lappas
authors: Nikolaos
authors: N
authors: Oikonomopoulos
authors: Vassilios
authors: V
authors: Smyrniotis
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D016022:Case-Control Studies; D003138:Common Bile Duct Neoplasms / Q000601:surgery*; D004322:Drainage / Q000009:adverse effects*; D004379:Duodenal Neoplasms / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D059413:Intraabdominal Infections / Q000209:etiology; D041781:Jaundice, Obstructive / Q000601:surgery; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D011300:Preoperative Care / Q000009:adverse effects*