Impact of combined preoperative and postoperative biliary drainage on outcome of pancreaticoduodenectomy

Background There is controversy about the effect of biliary drainage (BD) on the postoperative outcome of pancreaticoduodenectomy (PD). Preoperative BD can be achieved by endoscopic stent or ultrasound-guided percutaneous transhepatic drainage (PTD). There is no clear consensus on whether to manage malignant obstructive jaundice with preoperative BD prior to operative intervention or to proceed directly to resection. This is a retrospective study comparing patients who proceeded directly to PD surgery versus those who received a preoperative PTD to be continued postoperatively as regards the postoperative outcomes, mainly postoperative pancreatic fistula (POPF). Aim To elucidate the role of BD continued postoperatively on surgical outcomes after PD, mainly POPF. Patients and methods In total, 40 patients underwent PD with Kakitta pancreaticojejunostomy anastomosis for malignant jaundice, 11 received PTD as a preoperative BD continued postoperatively, while 29 patients proceeded directly for surgery. Results Both groups were comparable as regards major surgical outcomes, except for POPF, which was statistically lower in those who received PTD before surgery. Conclusion In patients with malignant jaundice requiring surgery, preoperative BD group continued postoperatively had significantly less POPF than the group that was managed with direct surgery without BD.