Preoperative Biliary Drainage for Patients with Perihilar Bile Duct Malignancy

Background Although endoscopic biliary stenting (EBS) is known to increase preoperative biliary drainage (PBD)-related complications including postoperative surgical site infection (SSI), EBS is still commonly placed before referral to tertiary centers. Whether exchanging EBS with external drainage methods mitigate the risk of SSI is unknown. This study sought to identify EBS-associated risk of recurrent biliary obstruction and postoperative SSI, with particular attention whether it was replaced with external drainage methods before surgery. Methods From January 2005 to December 2014, 102 consecutive patients with perihilar biliary cancer who underwent PBD followed by hepatobiliary resection were analyzed. Results Among the enrolled patients, 49 (48.0%) underwent total 76 re-interventions due to recurrent biliary obstruction with a median number of 1 (range, 1 to 6). Cholangitis occurred more frequently in patients with EBS (26.9%) than in other methods (P < 0.001). The incidence of postoperative SSI was marginally higher among the patients with EBS at the time of surgery than those with previously placed EBS replaced by the external drainage (72.2% vs 38.5%,P = 0.060). In the multivariate analysis, presence of EBS at the time of surgery remained as an only independent predictor of SSI (95% CI, 1.46-17.32;P = 0.011). Conclusions The use of EBS increased recurrent biliary obstruction and postoperative SSI particularly when it is present at a time of definitive operation. Our findings support using external drainage such as by endoscopic nasobiliary drainage because of the lower associated incidence of these complications.