EVALUATION OF SURGICAL RISK IN PREOPERATIVE BILIARY DRAINAGE PATIENTSBY BLOOD-CHEMISTRY LABORATORY DATA - WITH SPECIAL REFERENCE TO RATE OF REDUCTION OF SERUM BILIRUBIN LEVELS

Background/Aims: In Japan, it is generally accepted that biliary decom pression should be performed before surgical operations on patients wi th obstructive jaundice. However, even when adequate decompression and effective reduction of serum bilirubin levels are achieved before sur gical operations, it is not uncommon for unforeseen postoperative comp lications to occur. In this study, we analyzed the effectiveness of bi liary drainage prior to pancreatoduodenectomy in patients with maligna nt obstruction of the papilla of Vater clinically manifested by obstru ctive jaundice. Patients and Methods: We retrospectively examined the serial blood chemistry laboratory data of 44 patients with periampulla ry carcinoma who had preoperative obstructive jaundice and underwent p ancreatoduodenectomy during the last in years. We divided the cases in to three groups according to the rate of decrease in serum bilirubin l evels, ''b'' : group I, b<-0.09; group II, -0.09<b<-0.05; and group II I, -0.05<b. There were no significant differences between the three gr oups in regard to sex, location of tumor and method of biliary decompr ession, however, there was significantly higher morbidity rate in grou p III. Results: The level of biliary enzymes (gamma-CTP, ALP) tended t o be higher in group I and lower in group III. Although TB and DB decr eased to below 5 mg/dl before pancreatoduodenectomy in all three group s, transaminase levels instead rose in group Ill just before pancreato duodenectomy. Conclusion: This suggested that liver damage continued t o progress after biliary decompression when the reduction rate was low , and thus we should carefully monitor such patients for postoperative complications.