PREOPERATIVE BILE-SALT ADMINISTRATION VERSUS BILE REFEEDING IN OBSTRUCTIVE-JAUNDICE

Background. Endotoxaemia due to intraluminal bile salt depletion may b e a cause of renal failure in patients with obstructive jaundice. Admi nistration of bile salts to these patients has been reported to decrea se portal and systemic endotoxaemia during surgery and improve renal f unction. However, such changes have not been shown with bile refeeding . We compared the effect of preoperative bile salt administration with preoperative bile refeeding on renal function in patients with obstru ctive jaundice. Methods. Sixteen patients with obstructive jaundice un derwent percutaneous transhepatic biliary drainage-eight received oral bile salts (500 mg of sodium deoxycholate 8-hourly for 48 hours preop eratively) and the other 8 were refed the total bile output for the en tire period of biliary drainage (median 13 days). Blood endotoxin leve rs and renal function were assessed before, during and after the opera tion. Results. The number of patients with intraoperative portal and p ostoperative systemic endotoxaemia decreased after both forms of thera py. Renal function also improved in both the groups-all 4 patients wit h renal failure recovered. There was a significant increase in creatin ine clearance postoperatively after bile salt therapy (from 65 ml/minu te preoperatively to 87 ml/minute postoperatively). Conclusion. Refeed ing of bile obtained by percutaneous catheter drainage is an effective , cost-free substitute for oral bile salts in patients with obstructiv e jaundice.