Scientific paperEffect of preoperative biliary drainage on surgical outcome after pancreatoduodenectomy
Section snippets
Methods
All patients undergoing pancreatic head resection were selected from a prospectively collected statistical database. Registered data consisted of patient demographics, preoperative risk assessment according to the ASA classification scoring system in combination with preoperative spirometry and ergometry in most patients, preoperative biliary drainage procedures, standard hematological and biochemical laboratory tests, pathologic diagnosis, type of surgery performed and intraoperative findings,
Results
Between November 1993 and November 1999, 257 patients underwent pancreatic head resection and their data were prospectively collected in a statistical database. Patients’ demographics are summarized in Table 2. A total of 65 patients had a history of jaundice with a bilirubin level of >100 μmol/L on admission. Biliary instrumentation procedures prior to surgery are depicted in Table 3. A total of 184 patients (72%) underwent diagnostic biliary instrumentation and 99 patients had biliary
Comments
In the past, pancreatic surgery in patients with malignant obstruction of the common bile duct has been accompanied by a frightening mortality of 20% to 30% and morbidity rates of 40% to 60% [8]. Since these malignancies commonly occur in elderly patients, the coexistence of concomitant diseases such as malnutrition, history of cardiopulmonary disease, presence of cholangitis, and renal insufficiency may contribute to this high perioperative risk [8], [20], [26], [27], [28]. Moreover, several
References (38)
- et al.
Decreased morbidity and mortality after pancreatoduodenectomy
Am J Surg
(1986) - et al.
Percutaneous transhepatic drainage of the biliary tracttechnique and results in 104 cases
Gastroenterology
(1978) - et al.
Preoperative percutaneous transhepatic biliary decompression lowers operative morbidity in patients with obstructive jaundice
Am J Surg
(1981) - et al.
Preoperative external biliary drainage in obstructive jaundice. A prospective controlled clinical trial
Lancet
(1982) - et al.
Postoperative complications after thoracic and major abdominal surgery in patients with and without obstructive lung disease
Chest
(1993) - et al.
Bile acid-induced inhibition of the lymphoproliferative response to phytohemagglutinin and pokeweed mitogenan in vitro study
Gastroenterology
(1980) - et al.
Experimental and clinical studies on the effect of biliary drainage in obstructive jaundice
Am J Surg
(1981) - et al.
Endotoxemia, disturbance of coagulation, and obstructive jaundice
Am J Surg
(1982) - et al.
Reversibility of hepatic mitochondrial damage in rats with long-term cholestasis
J Hepatol
(1998) - et al.
Rapid normalization of hepatic glycogen metabolism in rats with long-term bile duct ligation after biliodigestive anastomosis
J Hepatol
(1999)
Reversibility of secondary biliary fibrosis by biliodigestive anastomosis in the rat
Gastroenterology
Hepatic functional reserve in patients with obstructive jaundicean assessment by the redox tolerance test
Am J Surg
Six hundred fifty consecutive pancreaticoduodenectomies in the 1990spathology, complications, and outcomes
Ann Surg
Pancreatic fistula after pancreatic head resectionanalysis of 331 consecutive patients
Br J Surg
Role of octreotide in the prevention of postoperative complications following pancreatic resection
Am J Surg
Efficacy of octreotide in the prevention of complications of elective pancreatic surgery. Italian Study Group
Br J Surg
Factors affecting morbidity and mortality after surgery for obstructive jaundicea review of 373 patients
Gut
Complications following pancreaticoduodenectomy. Current management
Arch Surg
Does preoperative percutaneous biliary drainage reduce operative risk or increase hospital cost?
Ann Surg
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The first two authors contributed equally to the manuscript.