Abstract
The aim of this study was to evaluate the potential effects of biliary drainage before pancreaticoduodenectomy on postoperative outcomes. This study was conducted retrospectively on data from 820 cases of pancreaticoduodenectomy performed in the Gastrointestinal Surgery Department of Ankara City Hospital between April 1999 and August 2019. Twenty years of collected patient data were re-examined and 805 patients were divided into two groups as those who underwent preoperative biliary drainage (PBD) and those who did not (non-PBD). Demographic data of patients, and preoperative, operative and postoperative details, including morbidity, were collected and compared between the two groups. There were 574 (71.3%) patients in the PBD group and 231 (28.6%) patients in the non-PBD group. Total complications according to Clavien-Dindo classification were significantly higher in the PBD group (P<0.001). Intraabdominal hemorrhage, delayed gastric emptying and wound infection were found to be higher in the PBD group but the rate of pancreatic fistula was similar in both groups. There was no difference between the two groups in terms of complications according to preoperative bilirubin levels. In drained patients with normal bilirubin levels, wound infections were significantly higher in a group with diameter of common bile duct>8 mm (P=0.020). PBD is not associated with anastomotic leakage after pancreaticoduodenectomy. Wound infection, delayed gastric emptying and intraabdominal hemorrhage were significantly associated with PBD. Preoperative bilirubin level had no effect on these results. In subgroup analysis, in patients undergoing drainage, if bilirubin falls below 5 mg/dL, the risk of wound infection was still high in patients with bile duct diameter>8 mm.
Highlights
Periampullary tumors are leading causes of biliary obstruction
Surgeons avoid stenting due to these adverse effects of preoperative stenting and the fact that dilated ducts provide more comfortable anastomosis for surgeons, biliary stenting is still common before pancreaticoduodenectomy due to referral of patients from different centers or reflex therapeutic stenting during diagnostic endoscopic retrograde cholangiopancreatography (ERCP)
A total of 574 (71.3%) of these patients were in the preoperative biliary drainage (PBD) group while the remaining 231 (28.6%) patients were in the Non-PBD group
Summary
Periampullary tumors (tumors originating from the head of the pancreas, ampulla vateri, duodenum, distal biliary tract) are leading causes of biliary obstruction. Some show adverse effects of biliary drainage on morbidity, resulting in infective conditions and some show no effect on postoperative complications.[8,9] surgeons avoid stenting due to these adverse effects of preoperative stenting and the fact that dilated ducts provide more comfortable anastomosis for surgeons, biliary stenting is still common before pancreaticoduodenectomy due to referral of patients from different centers or reflex therapeutic stenting during diagnostic endoscopic retrograde cholangiopancreatography (ERCP). This procedure is still mostly performed before the surgeon evaluates the patient.[10].
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