<abstract xmlns="http://www.w3.org/1999/xhtml"><sec id="j_abm-2019-0025_s_005_w2aab3b7b5b1b6b1aab1c16b1Aa"><h3>Background</h3><p>Preoperative biliary drainage (PBD) in patients with obstructive jaundice from periampullary neoplasms may reduce the untoward effects of biliary obstruction and subsequent postoperative complications. However, PBD is associated with bile contamination and increases infectious complications after pancreaticoduodenectomy (PD).</p></sec><sec id="j_abm-2019-0025_s_006_w2aab3b7b5b1b6b1aab1c16b2Aa"><h3>Objectives</h3><p>To determine whether PBD is associated with more complications after PD.</p></sec><sec id="j_abm-2019-0025_s_007_w2aab3b7b5b1b6b1aab1c16b3Aa"><h3>Methods</h3><p>Patients with obstructive jaundice from periampullary lesions who underwent PD from 2000 to 2015 at our institution were retrospectively enrolled. The cohort was divided into a group with PBD and a group without. PBD was performed using one of the following methods: endoprosthesis, percutaneous transhepatic biliary drainage, surgical biliary-enteric bypass, or T-tube choledochostomy. PDs were performed by the first author using uniform surgical techniques. Postoperative complications were recorded. Statistical analyses were conducted using an unpaired <italic>t</italic>, Fisher exact, or chi-squared tests as appropriate.</p></sec><sec id="j_abm-2019-0025_s_008_w2aab3b7b5b1b6b1aab1c16b4Aa"><h3>Results</h3><p>There were 26 with PBD and 28 patients without. Patients in the 2 groups were similar in age, presenting serum bilirubin level, operative time, operative blood transfusion, and hospital stay. The group with PBD had longer duration of jaundice, more patients presenting with cholangitis, and more patients with carcinoma of the ampulla of Vater. The overall complications were higher in patients in the group with PBD than in the group without.</p></sec><sec id="j_abm-2019-0025_s_009_w2aab3b7b5b1b6b1aab1c16b5Aa"><h3>Conclusions</h3><p>PBD was associated with more complications overall after PD. However, PBD was necessary and lifesaving in certain clinical situations and improved the condition of patients before they underwent PD. Routine PBD in patients with obstructive jaundice without definite indications is not recommended.</p></sec></abstract>

BackgroundPreoperative biliary drainage (PBD) in patients with obstructive jaundice from periampullary neoplasms may reduce the untoward effects of biliary obstruction and subsequent postoperative complications. However, PBD is associated with bile contamination and increases infectious complications after pancreaticoduodenectomy (PD).ObjectivesTo determine whether PBD is associated with more complications after PD.MethodsPatients with obstructive jaundice from periampullary lesions who underwent PD from 2000 to 2015 at our institution were retrospectively enrolled. The cohort was divided into a group with PBD and a group without. PBD was performed using one of the following methods: endoprosthesis, percutaneous transhepatic biliary drainage, surgical biliary-enteric bypass, or T-tube choledochostomy. PDs were performed by the first author using uniform surgical techniques. Postoperative complications were recorded. Statistical analyses were conducted using an unpaired t, Fisher exact, or chi-squared tests as appropriate.ResultsThere were 26 with PBD and 28 patients without. Patients in the 2 groups were similar in age, presenting serum bilirubin level, operative time, operative blood transfusion, and hospital stay. The group with PBD had longer duration of jaundice, more patients presenting with cholangitis, and more patients with carcinoma of the ampulla of Vater. The overall complications were higher in patients in the group with PBD than in the group without.ConclusionsPBD was associated with more complications overall after PD. However, PBD was necessary and lifesaving in certain clinical situations and improved the condition of patients before they underwent PD. Routine PBD in patients with obstructive jaundice without definite indications is not recommended.

Outcomes of pancreaticoduodenectomy in patients with obstructive jaundice with and without preoperative biliary drainage: a retrospective observational study

Asian Biomedicine

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

BackgroundPreoperative biliary drainage (PBD) in patients with obstructive jaundice from periampullary neoplasms may reduce the untoward effects of biliary...

	All patients			Group 1			Group 2			P
	Range	Mean	Median	Range	Mean	Median	Range	Mean	Median
Age (years)	33–89	62.9 ± 12.7	63.5	36–78	59.7 ± 11.0	62	33–89	65.9 ± 13.5	67	NS
Presenting serum bilirubin (mg%)	5.5–52.7	21.4 ± 11.5	20.6	8.7–52.0	24.4 ± 12.2	21.2	5.5–52.7	19.3 ± 10.5	20.3	NS
Duration of jaundice (days)	7–120	38.5 ± 34.0	30	7–120	52.5 ± 43.1	42	8–60	26.1 ± 14.5	30	0.0035
Operative time (minute)	300–780	420.6 ± 82.8	420	300–780	423.5 ± 96.8	420	300–540	417.9 ± 67.1	420	NS
Operative blood transfusion (unit)	0–7	2.7 ± 1.7	3	0–7	2.8 ± 2.0	3	0–5	2.6 ± 1.4	2.5	NS
Hospital stay (days)	12–106	28.9 ± 17.8	22.5	12–106	31.8 ± 23.3	23.5	15–45	26.1 ± 9.5	21	NS

Pathological diagnosis	All patients	Group 1	Group 2	P
Carcinoma of the head of the pancreas	23	10	13	NS
Carcinoma of the ampulla of Vater	20	14	6	0.029
Carcinoma of the distal common bile duct	5	0	5	NS
Chronic pancreatitis	2	0	2	NS
Carcinoma of the duodenum	1	0	1	NS
Acute pancreatitis	1	1	0	NS
Sarcoma of the pancreatic head	1	0	1	NS
Neuroendocrine tumor of the pancreas	1	1	0	NS
Total	54	26	28

	Group 1 (n = 26)	Group 2 (n = 28)	P
PPPD	20	26	NS
Classical PD	6	2	NS
Cholangitis	11	0	< 0.0001
No cholangitis	15	28	NS

Complication	Group 1 (12 in 26)*	Group 2 (7 in 28)*	P
Wound infection	3	3	NS
Grade A pancreatic fistula	5	1	NS
Early delayed gastric emptying	2	2	NS
Intraabdominal bleeding	2	1	NS
Intraabdominal collection	5	1	NS
Congestive heart failure	0	1	NS
Overall complications	17	9	0.03

Outcomes of pancreaticoduodenectomy in patients with obstructive jaundice with and without preoperative biliary drainage: a retrospective observational study

Article Category: Brief communication (original)

Published Online: Oct 01, 2019

Page range: 237 - 241

DOI: https://doi.org/10.1515/abm-2019-0025

Keywords
cholangitis, digestive system surgical procedures, drainage, jaundice, Pancreaticoduodenectomy

© 2018 Suvit Sriussadaporn et al., published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

Demographics and perioperative data of patients undergoing pancreaticoduodenectomy

Pathological diagnosis of the periampullary lesions

Cholangitis at presentation and operative procedure (classical PD or PPPD)

Postoperative complications

Outcomes of pancreaticoduodenectomy in patients with obstructive jaundice with and without preoperative biliary drainage: a retrospective observational study

Article Category: Brief communication (original)

Published Online: Oct 01, 2019

Page range: 237 - 241

DOI: https://doi.org/10.1515/abm-2019-0025

Keywordscholangitis, digestive system surgical procedures, drainage, jaundice, Pancreaticoduodenectomy

© 2018 Suvit Sriussadaporn et al., published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

Demographics and perioperative data of patients undergoing pancreaticoduodenectomy

Pathological diagnosis of the periampullary lesions

Cholangitis at presentation and operative procedure (classical PD or PPPD)

Postoperative complications

Keywords
cholangitis, digestive system surgical procedures, drainage, jaundice, Pancreaticoduodenectomy