SIGNIFICANCE OF PREOPERATIVE PERCUTANUOUS TRANSHEPATIC BILIARY DRAINAGE FOR OBSTRUCTIVE JAUNDICE

Abstract

Eighty-five patients, with malignant obstructive jaundice whose serum T-bilirubin (T-Bil) were less than 10 mg/dl were allocated to pancreaticoduodenectomy. In order to study the significance of the preoperative percutaneous transhepatic biliary drainage (PTBD), the 85 patients were divided into 3 groups according to serum T-Bil level, namely, group A comprising of 26 with serum T-Bil levels of more than 3mg/dl with preoperative PTBD; group B comprising of 9 with the levels of more than 3mg/dl without PTBD; and group C comprising of 50 with the levels of lesser than 3mg/dl without PTBD. Furthermore, complications of PTBD were evaluated in 469 patients with benign or malignant obstructive jaundice for the same period. After pancreaticoduodenectomy the morbidity was 23% in group A, 22% in group B, or 30% in group C, while the mortality was 8%, 0%, or 4% respectively, with no remarkable difference. These figures might indicate operative risks themselves. On the other hand, post-PTBD morbidity was not so low as 16.8% and the mortality 1.1%. Preoperative PTBD did not reduce operative risks. Therefore in patients with malignant biliary obstruction presenting serum T-Bil levels of less than 10mg/dl, pancreaticoduodenectomy should be performed without preoperative PTBD.