PREOPERATIVE BILIARY DRAINAGE, COLONIZATION OF BILE AND POSTOPERATIVECOMPLICATIONS IN PATIENTS WITH TUMORS OF THE PANCREATIC HEAD - A RETROSPECTIVE ANALYSIS OF 241 CONSECUTIVE PATIENTS

Objective: To analyse the outcome of preoperative biliary drainage in patients being operated on for a tumour in the pancreatic head. Design : Retrospective study. Setting: University hospital, The Netherlands. Subjects: Consecutive series of 241 patients. Main outcome measures: D ecline in bilirubin concentrations and bacterial contamination of bile as a result of preoperative drainage. Incidence of postoperative comp lications in patients who underwent preoperative drainage and those wh o did not. Results: 184/241 patients underwent preoperative biliary dr ainage. Endoscopic drainage was the most effective, shown by a median reduction in bilirubin concentrations of 82%, 74%, and 50% after endos copic drainage (n = 149), papillotomy (n = 25) and external drainage ( n = 10), respectively. Bacterial contamination of bile was significant ly more common when an endoprosthesis was used, but did not result in a higher rate of infective complications. 163 Whipple's resections, 33 total pancreatectomies, and 45 biliary-enteric bypasses were performe d. 137/241 (57%) patients had postoperative complications. There was n o significant difference in the incidence of postoperative complicatio ns between patients who had preoperative biliary drainage and those wh o did not (p = 0.4).