Abstract
Background. The role of preoperative biliary stenting (PBS) before pancreaticoduodenectomy (PD) in patients with obstructive jaundice is debatable. The objective of the current study was to assess PD outcomes after upfront surgery or PBS and determine the impact of stent to surgery duration on PD outcomes. Methods. We reviewed patients who underwent PD between 2011 and 2019. Patients were grouped based on whether they underwent upfront surgery (n = 67) or PBS (n = 66). We further assessed outcomes based on stent to surgery duration. Results. There was no significant difference in 30-day mortality (3% vs. 2.9%, P = 1), 90-day mortality (7.5% vs. 4.4%, P = .4), and Grade B-C pancreatic fistula rates (7.5% vs. 4.4%, P = .4) in the PBS and upfront surgery groups, respectively. A significant increase in wound infections (22.7% vs. 7.4%, P = .01) and readmissions (10.6% vs. 0, P = .006) was seen in the PBS group. The highest rate of wound infection was seen when stent to surgery duration was 4-6weeks (41.6%). The wound infection rates in the upfront surgery group, high-risk PBS group (4-6weeks), and low-risk PBS group were 5/67(7.4%), 5/12(41.6%), and 7/36(19.4%), respectively (P = .008). Conclusions. PBS increases postoperative wound infections when compared with upfront surgery. Patients operated between 4 and 6weeks after stenting have the highest rate of wound infection.
Highlights
Role of preoperative biliary stenting(PBS) in jaundiced patients with peri-ampullary malignancy is debatable
A significant increase in wound infections (7% vs 25%)(P=0.003), overall infectious complications (22.5% vs 38.1%)(P=0.04), re admissions (0 vs 10.5%)(P=0.005) and hospital stay (9 vs 10 days)(P=0.006) was seen in the PBS group
There was no significant difference in 30 day mortality (2.8 % vs 6.5%)(P=0.4)
Summary
Role of preoperative biliary stenting(PBS) in jaundiced patients with peri-ampullary malignancy is debatable It was introduced in 1960s to reduce the risk of infections and anastomotic leaks after pancreaticodoudenectomy (PD) [1, 2]. A direct relationship between rate of postoperative infections and morbidity has been shown in patients with PBS [6, 7]. This has challenged the conventional approach of routine PBS but raises questions regarding the timing of surgery after biliary drainage, and the impact of delay in surgical intervention on postoperative outcomes.
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