Scientific paper
Effect of preoperative biliary drainage on surgical outcome after pancreatoduodenectomy

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Abstract

Background: The role of preoperative biliary drainage in patients with biliary obstruction undergoing pancreatoduodenectomy remains controversial. Several authors failed to show any effect of preoperative biliary drainage, whereas others even reported an increased morbidity following pancreatoduodenectomy.

Methods: Retrospective analysis was performed in a consecutive series of 257 patients undergoing pancreatoduodenectomy between November 1993 and November 1999.

Results: Ninety-nine patients (38%) underwent preoperative biliary drainage for a median time period of 10 days (range 1 to 41) prior to resection. Cumulative postoperative morbidity was 47% (120 patients), the reoperation rate was 4.3% (11 patients), and mortality was 2.3% (6 patients). There was no difference in total morbidity, infectious complications, reoperation rate, mortality, or long-term survival between patients with or without preoperative biliary drainage.

Conclusions: Preoperative biliary instrumentation and biliary drainage do not affect early or late outcome in patients undergoing 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

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  • Cited by (0)

    The first two authors contributed equally to the manuscript.

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