Präoperative Gallenwegsdrainage vor Duodenopankreatektomie bei Patienten mit mechanischem Ikterus

Abstract

BACKGROUND: Surgery in patients with malignant obstructive jaundice is associated with high morbidity and mortality rates. Preoperative biliary drainage (PBD) has been used in an attempt to improve the outcome in these patients. This study was performed to determine the role of PBD in obstructive jaundice. METHODS: In a retrospective study, we evaluated the effect of endoscopic PBD in patients with malignant obstructive jaundice. At the 1st Surgical Department, Charles University, Prague, a cohort of 304 patients who had undergone pancreaticoduodenectomy from January 1990 to December 2002 was studied. In 144 patients (group A) internal PBD was carried out, while 160 patients (group B) were operated without PBD. RESULTS: No significant difference was found between groups A and B in sex distribution, presence of medical risk factors, duration of surgery, operative blood loss, stage of disease, waiting time for the operation, length of hospital stay, and mortality rates. Group A compared to group B patients showed higher age (P = 0.05), higher preoperative plasma bilirubin levels (118 vs. 81 μmol/l; P = 0.01), and higher rates of overall complications (61 [42.4%] vs. 40 [25%]; P = 0.05) and infectious complications (43 [29%] vs. 21 [13%]; P = 0.05). CONCLUSIONS: PBD patients developed more infectious complications and overall complications. On the other hand, they were of higher age and had higher preoperative plasma bilirubin levels. Endoscopic retrograde cholangiopancreatography and endoscopic drainage are only indicated in patients with distal obstruction and higher serum bilirubin levels when early surgery is not feasible. Otherwise, magnetic resonance cholangiopancreatography without PBD is preferable.