Increased bacterobilia associated with preoperative biliary drainage in patients with hilar cholangiocarcinoma

Abstract

Background Internal biliary drainage is known to reverse many of the pathophysiological disturbances seen in jaundiced patients. However, previous studies examining the effectiveness of preoperative biliary drainage in reducing morbidity and mortality rates in patients undergoing surgical intervention have been disappointing. The aim of this study was to evaluate the effect of preoperative biliary stenting on the incidence of bacterobilia and postoperative complications following surgical treatment of hilar cholangiocarcinoma. Methods Between 1988 and 1998, 127 patients with hilar cholangiocarcinoma were managed in a tertiary referral unit. Forty seven of these patients (37%) underwent curative resection or palliative biliary bypass procedures. Postoperative morbidity and mortality rates were compared in patients who had preoperative biliary drainage (PBD) (n = 20) and those who had no preoperative biliary drainage (NPBD) (n = 27). Results The median bilirubin concentration fell significantly in the PBD group after stent insertion and was significantly lower than in the NPBD group at the time of surgical intervention (110 mmol/L in PBD group versus 335 mmol/L in NPBD group; p Discussion Preoperative biliary drainage for hilar cholangiocarcinoma significantly increases the incidence of contaminated bile. A satisfactory period of preoperative biliary drainage does not reduce the incidence of postoperative complications in patients undergoing surgical intervention and is associated with increased hospital stay.