title: Value of preoperative biliary drainage on postoperative outcome after pancreaticoduodenectomy: A case-control study.
abstract: OBJECTIVE
  The potential benefit of preoperative biliary drainage (PBD) on postoperative outcomes remains controversial. The aim of this study was to elucidate surgical outcomes of pancreaticoduodenectomy (PD) in patients with PBD and to show the impact of bilirubin level.
  
  
  METHODS
  We retrospectively studied all patients who underwent PD in our center between January 2003 and June 2015. Patients were divided into: Group A (PBD) and Group B (no PBD). The primary outcome was the rate of postoperative complication.
  
  
  RESULTS
  A total of 588 cases underwent PD. Group A included 314 (53.4%) patients while Group B included 274 (46.6%) patients. The overall incidence of complications and its severity were higher in Group A (p = 0.03 and p = 0.02). There was significant difference in the incidence of postoperative pancreatic fistula (p = 0.002), delayed gastric emptying (p = 0.005), biliary leakage (p = 0.04), abdominal collection (p = 0.04), and wound infection (p = 0.04) in Group A. The mean length of hospital stay was significantly longer in Group A than in Group B (12.86 ± 7.65 days vs. 11.05 ± 7.98 days, p = 0.01). No significant impact of preoperative bilirubin level on surgical outcome was detected.
  
  
  CONCLUSIONS
  PBD before PD was associated with major postoperative complications and stent-related complications.
authors.affiliation: Gastroenterology Surgical Center, Mansoura University, Mansoura, Egypt. Electronic address: elnakeebayman@yahoo.com.
authors.forename: Ayman
authors.initials: A
authors.lastname: El Nakeeb
authors.affiliation: Gastroenterology Surgical Center, Mansoura University, Mansoura, Egypt.
authors.forename: Ali
authors.initials: A
authors.lastname: Salem
authors.affiliation: Gastroenterology Surgical Center, Mansoura University, Mansoura, Egypt.
authors.forename: Yousef
authors.initials: Y
authors.lastname: Mahdy
authors.affiliation: Gastroenterology Surgical Center, Mansoura University, Mansoura, Egypt.
authors.forename: Mohamed
authors.initials: M
authors.lastname: El Dosoky
authors.affiliation: Gastroenterology Surgical Center, Mansoura University, Mansoura, Egypt.
authors.forename: Rami
authors.initials: R
authors.lastname: Said
authors.affiliation: Gastroenterology Surgical Center, Mansoura University, Mansoura, Egypt.
authors.forename: Mohamed Abd
authors.initials: MA
authors.lastname: Ellatif
authors.affiliation: Gastroenterology Surgical Center, Mansoura University, Mansoura, Egypt.
authors.forename: Helmy
authors.initials: H
authors.lastname: Ezzat
authors.affiliation: Gastroenterology Surgical Center, Mansoura University, Mansoura, Egypt.
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Elsabbagh
authors.affiliation: Gastroenterology Surgical Center, Mansoura University, Mansoura, Egypt.
authors.forename: Hosam
authors.initials: H
authors.lastname: Hamed
authors.affiliation: Gastroenterology Surgical Center, Mansoura University, Mansoura, Egypt.
authors.forename: Talaat Abd
authors.initials: TA
authors.lastname: Alah
authors.affiliation: Gastroenterology Surgical Center, Mansoura University, Mansoura, Egypt.
authors.forename: Gamal
authors.initials: G
authors.lastname: El Ebidy
mesh_terms: D000328:Adult; D000368:Aged; D001659:Biliary Tract / Q000503:physiopathology; D016022:Case-Control Studies; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods; D004322:Drainage / Q000009:adverse effects* / Q000379:methods; D004534:Egypt; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010185:Pancreatic Fistula / Q000517:prevention & control*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D015607:Stents / Q000009:adverse effects*; D016896:Treatment Outcome
keywords: endoscopic retrograde cholangiopancreatography; obstructive jaundice; pancreaticoduodenectomy; periampullary; postoperative pancreatic fistula