Effect of preoperative biliary decompression on pancreaticoduodenectomy-associated morbidity in 300 consecutive patients

Objective To examine the relationship between preoperative biliary drainage and the m orbidity and mortality associated with pancreaticoduodenectomy. Summary Background Data Recent reports have suggested that preoperative biliary drainage increases the perioperative morbidity and mortality rates of pancreaticoduodenectomy. Methods Peri-operative morbidity and mortality were evaluated in 300 consecutive pa tients who underwent pancreaticoduodenectomy, Univariate and multivariate l ogistic regression analyses were done to evaluate the relationship between preoperative biliary decompression and the following end points: any compli cation, any major complication, infectious complications, intraabdominal ab scess, pancreaticojejunal anastomotic leak, wound infection, and postoperat ive death. Results Preoperative prosthetic biliary drainage was performed in 172 patients (57% ) (stent group), 35 patients (12%) underwent surgical biliary bypass perfor med during prereferral laparotomy, and the remaining 93 patients (31%) (no- stent group) did not undergo any form of preoperative biliary decompression . The overall surgical death rate was 1% (four patients); the number of dea ths was too small for multivariate analysis. By multivariate logistic regre ssion, no differences were found between the stent and no-stent groups in t he incidence of all complications, major complications, infectious complica tions, intraabdominal abscess, or pancreaticojejunal anastomotic leak. Woun d infections were more common in the stent group than the no-stent group. Conclusions Preoperative biliary decompression increases the risk for postoperative wou nd infections after pancreaticoduodenectomy. However, there was no increase in the risk of major postoperative complications or death associated with preoperative stent placement. Patients with extrahepatic biliary obstructio n do nor necessarily require immediate laparotomy to undergo pancreaticoduo denectomy with acceptable morbidity and mortality rates; such patients can be treated by endoscopic biliary drainage without concern for increased maj or complications and death associated with subsequent pancreaticoduodenecto my.