Preoperative biliary drainage before resection in obstructive jaundice

Background: Surgery for patients with malignant obstructive jaundice carrie s high morbidity and mortality rates. Preoperative biliary drainage (PBD) h as been used in an attempt to improve the outcome in these patients, Aim: T o review the evidence in the literature on whether PBD improves postoperati ve morbidity and mortality in obstructive jaundice patients. Method: Using Medline a literature search was performed for papers published in English f rom January 1980 to October 2000, using the text words 'obstructive jaundic e', 'preoperative', 'drainage' and 'stent', All retrieved papers which repo rted experimental or clinical observations relevant to the study aim were c arefully analysed and the findings are summarised in this review. Results a nd Conclusion: There is no evidence in the literature to support the view t hat routine PBD improves postoperative morbidity and mortality in patients with obstructive jaundice undergoing resection. PBD has its own complicatio ns that cancel out its benefits. However, PBD could be beneficial in patien ts presenting with sepsis, coagulation abnormalities or malnutrition. (C) 2 001 S. Karger AG, Basel.