The effect of preoperative biliary drainage on postoperative complicationsafter pancreaticoduodenectomy

BACKGROUND: The benefit of preoperative biliary drainage in jaundiced patie nts undergoing pancrearicoduodenectomy for a suspected malignancy of the pe riampullary region is still under debate. This study evaluated preoperative biliary drainage in relation to postoperative outcomes. STUDY DESIGN: At the Academic Medical Center, Amsterdam, the Netherlands, a cohort of 311 patients undergoing pancreaticoduodenectomy from June 1992 u p to and including December 1999 was studied. Of this cohort 21 patients wi th external or surgical biliary drainage were excluded and 232 patients who had received preoperative internal biliary drainage were divided into thre e groups corresponding with severity of jaundice according to preoperative plasma bilirubin levels: <40 <mu>M (n = 177), 40 to 100 muM (n = 32), and > 100 muM (n = 23) were designated as groups 1, 2, and 3, respectively. Thes e groups were compared with patients who underwent immediate surgery (n = 5 8) without preoperative drainage. RESULTS: The median number of stent (re)placements was 2 (range 1 to 6) wit h a median drainage duration of 41 days (range 2 to 182 days) and a stent d ysfunction rate of 33%. Although patients in group 1 were better drained th an patients in groups 2 and 3 (median reduction of bilirubin levels 82%, 57 %, and 37%, respectively, p < 0.01), there was no difference in overall mor bidity among the drained groups (50%, 50%, and 52%, respectively). There wa s no significant difference in overall morbidity between patients with and without preoperative biliary drainage (50% and 55%, respectively). CONCLUSIONS: Preoperative biliary drainage did not influence the incidence of postoperative complications, and although it can be performed safely in jaundiced patients it should not be used routinely. (J Am Coll Surg 2001;19 2:726-734. (C) 2001 by the American College of Surgeons).