Effect of preoperative biliary drainage on surgical outcome after pancreatoduodenectomy

Background: The role of preoperative biliary drainage in patients with bili ary obstruction undergoing pancreatoduodenectomy remains controversial. Sev eral authors failed to show any effect of preoperative biliary drainage, wh ereas others even reported an increased morbidity following pancreatoduoden ectomy. Methods: Retrospective analysis was performed in a consecutive series of 25 7 patients undergoing pancreatoduodenectomy between November 1993 and Novem ber 1999. Results: Ninety-nine patients (38%) underwent preoperative biliary drainage for a median time period of 10 days (range 1 to 41) prior to resection. Cu mulative postoperative morbidity was 47% (120 patients), the reoperation ra te was 4.3% (11 patients), and mortality was 2.3% (6 patients). There was n o difference in total morbidity, infectious complications, reoperation rate , mortality, or long-term survival between patients with or without preoper ative biliary drainage. Conclusions: Preoperative biliary instrumentation and biliary drainage do n ot affect early or late outcome in patients undergoing pancreatoduodenectom y. (C) 2001 Excerpta Medica, Inc. All rights reserved.