Clinical Analysis of Biliary Drainage effect on outcome after Pancreaticoduodenectomy

Min, Kyu Hong; Lee, Kyung Bum; Min, Byung Wook; Hong, Jeong Hun; Song, Tae Jin; Suh, Sung Ock; Kim, Young Chul; Choi, Sang Yong

Abstract

BACKGROUND/AIMS: Pancreaticoduodenectomy is accompanied by considerable rates of postoperative complications and mortalities. Obstructive jaundice is associated with periampullary lesions. The role of preoperative biliary drainage in patients with biliary obstruction undergoing pancreaticoduodenectomy remains controversial. Some authors show the disadvantages of biliary drainage that increased perioperative infectious complications. We analyzed retrospectively the effect of biliary drainage on pancreaticoduodenectomy and surgical outcome.
METHODS
One hundred ten consecutive cases of pancreaticoduodenectomy performed between March 1992 and December 2000 were analyzed. We classified Group A as the patients who performed preoperative biliary drainage and Group B as the patients who did not perform biliary drainage. Multiple preoperative, intraoperative, postoperative variables were examined. Student's T-test, chisquare test or Fisher's Exact test was used for univariate comparison of all variables.
RESULTS
Preoperative Biliary drainage was performed in 52 patients (47%) and the remaining 58 patients (53%) did not undergo any form of biliary drainages. The overall morbidity and mortality was 37% and 1.8% each. Total Bilirubin was higher in Group A (13.15 mg/dl) than Group B (4.11 mg/dl) (P=0.000). In Group A complication occurred in 21 patients and 20 patients in Group B (P=0.561). No differences were found between Group A and Group B in the incidence of all complications. More transfusion was needed for Group A (P=0.043). Postoperative hospital stay presented no differences (P=0.375).
CONCLUSIONS
Biliary drainage is not required in patients who are planed pancreaticoduodenectomy except that the patient had cholangitis or bleeding tendency due to jaundice and hepatic derangements. The biliary drainage should be reserved for the potential for delay in definitive surgery. And it demands randomized prospective study in the future.