Outcome following pancreaticoduodenectomy in patients undergoing preoperative biliary drainage

Objective: To assess the role of preoperative biliary drainage (PBD) in the early outcome following pancreaticoduodenectomy (PD) for periampullary tumors. Design: Retrospective analysis of prospective database. Patients and Methods: 121 PDs were performed for periampullary tumors between 1989 and 1998. 54 patients were operated following a PBD (group A) while 67 patients were operated without PBD. 50 patients underwent internal biliary drainage while 4 patients underwent external biliary drainage. Of the 67 patients without PBD, serum bilirubin was >10 mg% in 41 patients (group B) while 26 patients had bilirubin level of <10 mg% (group C). Result: Patients were well matched for age, sex distribution, presence of medical risk factors, duration of surgery, operative blood loss and stage of disease. Group A patients had a higher incidence of wound infection (43 vs. 24%; p=0.03), intra-abdominal abscess (28 vs. 15%; p=0.06), pancreaticojejunal anastomotic leak (20 vs. 5%; p=0.01) and overall infective complications (52 vs. 29%; p=0.01) compared to group B patients, and a higher overall infective complication rate than group C patients (52 vs. 27%; p=0.02). Group B patients had a higher incidence of intra-abdominal bleeding compared to group A (20 vs. 6%; p=0.01) and group C patients (20 vs. 4%; p=0.03). Reoperation rate was significantly higher in group B compared to group A patients (27 vs. 13%; p=0.04). The mortality rates were not significantly different in the three groups. Conclusion: Patients with jaundice (>10 mg%) have a higher risk of bleeding complications while those with PBD have more infective complications. PBD should be judicially employed in selected patients. Copyright (C) 2001 S. Karger AG, Basel.