Value of Preoperative biliary drainage on postoperative outcome after pancreaticoduodenectomy: a case-control study

Abstract

Introduction: The potential benefit of the preoperative biliary drainage (PBD) on postoperative outcomes remains controversial. The aim of this study was to elucidate surgical outcomes of pancreatoduodenectomy (PD) in patients with PBD and to show the impact of preoperative bilirubin level. Method: We retrospectively studied all patients who underwent PD in our center between January 2000 and June 2014. Group A (patients with PBD) and Group B (patients with non-PBD). The primary outcome was the rate of postoperative complications and their severity. Results: A total number of 588 cases underwent PD. Group A included 314 (53.4%) patients while group B included 274 (46.6%) patients. The overall incidence of complications and its severity were higher in PBD group (P = 0.03 and 0.02). There was significant difference in the incidence of postoperative pancreatic fistula (P = 0.002), delayed gastric emptying (P = 0.005), biliary leakage (P = 0.04), abdominal collection (P = 0.04) and wound infection (P = 0.04) in PBD group. The mean length of hospital stay was significantly longer in PBD group than in non PBD group (12.86 ± 7.65 days vs 11.05 ± 7.98 days, P = 0.01). No significant impact of preoperative bilirubin level on surgical outcome. Conclusions: PBD before PD was associated with major postoperative complications and stent related complications.