Efficacy Of Preoperative Biliary Drainage Research Articles

The impact of preoperative biliary drainage on postoperative outcomes in patients with malignant obstructive jaundice: a retrospective analysis of 290 consecutive cases at a single medical center

BackgroundThe efficacy of preoperative biliary drainage (PBD) has been debated for several decades, and yet indications for PBD remain controversial. The aim of this study was to compare the postoperative morbidity and mortality in patients with malignant obstructive jaundice undergoing direct surgery versus surgery with PBD.MethodsAll consecutive patients with malignant obstructive jaundice who underwent radical resection between June 2017 and December 2019 at Zhongshan Hospital were analyzed retrospectively. The study population was divided into two groups: PBD group (PG) and direct surgery group (DG). The subgroups were chosen based on the site of obstruction. Perioperative indicators and postoperative complications were compared and analyzed.ResultsA total of 290 patients were analyzed. Postoperative complications occurred in 134 patients (46.4%). Patients in the PG group had a lower overall rate of postoperative complications compared with the DG group, with perioperative total bilirubin (TB) identified as an independent risk factor in multivariate analysis (hazard ratio = 1.004; 95% confidence interval 1.001–1.007; P = 0.017). Subgroup analysis showed that PBD reduced the complication rate in patients with proximal obstruction. In the proximal-obstruction subgroup, a preoperative TB level > 162 μmol/L predicted postoperative complications.ConclusionsPBD may reduce the overall rate of postoperative complications among patients with proximal malignant obstructive jaundice.Trial registrationClinicalTrials.gov, 2018ZSLC 24. Registered May 17, 2018, https://clinicaltrials.gov/.

Meta-analysis of the efficacy of preoperative biliary drainage in patients undergoing liver resection for perihilar cholangiocarcinoma

PurposeA systematic review was performed to evaluate the effect of preoperative biliary drainage (PBD) on outcomes after liver resection in perihilar cholangiocarcinoma (PHCC) patients. MethodMEDLINE and Web of Science were searched up to March 2019. All studies assessing morbidity, mortality, or recurrence in patients who received PBD and hepatectomy for PHCC were included. Mantel–Haenszel tests with a random-effects model were used for meta-analysis. ResultsSixteen studies involving 2162 patients were included. PBD was associated with higher major morbidity odds ratio [OR] = 1.51; 95 % confidence interval [CI] = 1.14–2.00). Selecting patients for PBD based on simple selection criteria was associated with significantly higher major morbidity (OR = 1.57; 95 % CI = 1.10–2.25). In contrast, selecting patients for PBD according to strict criteria resulted in lower major morbidity compared with patients without PBD (OR = 0.51; 95 % CI = 0.18–1.42). PBD did not influence mortality (OR = 1.06; 95 % CI = 0.70–1.61). Tumor recurrence was significantly higher in the PBD group (OR = 2.07; 95 % CI = 1.38–3.11). To decrease PBD-related complications, the duration between PBD and hepatectomy should be shorter than two weeks. Most reports described PBD on the future liver remnant side. ConclusionsRoutine PBD cannot be recommended but it may be useful in highly selected patients suffering from cholangitis, malnutrition, and long lasting jaundice, for whom an extended hepatectomy is planned. However, However, routine PBD cannot be recommended due to higher morbidity rate after hepatectomy clear patient selection criteria can be defined for PBD in future multicenter randomized controlled studies.

Efficacy of preoperative biliary drainage in the pancreaticoduodenectomy for malignant obstructive jaundice: a Meta analysis

Objective To evaluate the efficacy of preoperative biliary drainage (PBD) in the pancreaticoduodenectomy for malignant obstructive jaundice. Methods Database including PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Academic Degree Dissertation Database and Conference Database were searched with malignant obstructive ,pancreaticoduodenectomy, preoperative biliary drainage, comparative study. Literatures about the randomized controlled trials of PBD (PBD group) and efficacy of early surgery (ES group) in the pancreaticoduodenectomy were retrieved from January 2001 to December 2013, and then a Meta analysis was carried out based on the data. The count data were analyzed using the odds ratio (OR) , relative risk (RR) and 95% confidence interval (95%CI) , and the measurement data were analyzed using mean difference (MD) and 95%CI. The heterogeneity of the data was analyzed using the I2 test. Data were integrated by fixed or random effect model. Results Twelve literatures including 1 982 patients were selected. There were 1 029 patients in the PBD group and 953 in the ES group. The results of Meta analysis showed that the operation time, volume of blood loss and rate of postoperative wound infection in the PBD group were significantly different from those in the ES group (MD =10.50, 107.92, 95%CI:6.34-14.66 , 16.43-199.42; RR =1.62, 95%CI: 1.19-2.21, P 0.05) . Conclusion PBD in the pancreaticoduodenectomy for malignant obstructive jaundice cannot reduce postoperative mortality and incidence of complications in patients, and should not be used as the conventional management in the perioperative period. Key words: Obstructive jaundice; Pancreaticoduodenectomy; Biliary drainage; Meta analysis

Operable severe obstructive jaundice: How should we use pre-operative biliary drainage?

Obstructive jaundice is a common surgical problem, and surgery in jaundiced patients is associated with a higher risk of postoperative complications than surgery in non-jaundiced patients. However, the efficacy of pre-operative biliary drainage (PBD) for patients with obstructive jaundice remains controversial. Many studies have been unable to confirm the benefit of PPB and have suggested that it should not be performed routinely. While we agree that routine PBD is not recommended for all jaundiced patients, we believe that it is useful for certain subgroups; however, there are no clear guidelines regarding its application in these subgroups. We suggest that further large and detailed randomised control studies should focus on formulating codes and standards of PBD for patients with operable conditions causing severe obstructive jaundice.

A meta-analysis on the efficacy of preoperative biliary drainage for tumors causing obstructive jaundice.

To review the effectiveness of preoperative biliary drainage (PBD) in patients with obstructive jaundice resulting from tumors. This was a systematic review, including a meta-analysis, of randomized controlled trials and comparative cohort studies conducted worldwide and published between 1966 and September 2001, classified on methodologic strength and subdivided into level 1 (randomized controlled trials) and level 2 (comparative cohort studies). Comparison was made of PBD versus no PBD in jaundiced patients undergoing resection of a tumor. Outcome measures were in-hospital death rate, overall complications resulting from the treatment modality (drainage- and surgery-related complications), and hospital stay. Effect sizes were calculated and combined in meta-analyses. Relative differences (%) were calculated to compare effects on outcome measures. Five randomized controlled studies comprising 302 patients met the inclusion criteria for level 1 studies, and 18 cohort studies comprising 2,853 patients met the criteria for level 2 studies. Meta-analysis of level 1 studies showed no difference in the overall death rate between patients who had PBD and those who had surgery without PBD. The overall complication rate, however, was significantly adversely affected by PBD compared with surgery without PBD. At level 2, there was no difference in the death rate between the two treatment modalities. The overall complication rate, however, was significantly adversely affected by PBD compared with surgery without PBD. If PBD had been without complications, then complications would be in favor of drainage based on level 1 studies, and no difference based on level 2 studies. Further, PBD was not able to reduce the length of postoperative hospital stay compared with surgery without PBD; instead, it prolonged the stay. This meta-analysis shows that PBD with current standards for patients with obstructive jaundice resulting from tumors carries no benefit and should not be performed routinely. The potential benefit of PBD in terms of postoperative rates of death and complications does not outweigh the disadvantage of the drainage procedure. Only if PBD-related complications could be reduced by 27% and consequently diminish hospital stay could PBD be beneficial. Further randomized controlled trials with improved PBD techniques are necessary.

To drain or not to drain: a meta-analysis on the efficacy of preoperative biliary drainage for tumors causing obstructive jaundice.

To drain or not to drain: a meta-analysis on the efficacy of preoperative biliary drainage for tumors causing obstructive jaundice.

To drain or not to drain: A meta-analysis on the efficacy of preoperative biliary drainage for tumors causing obstructive jaundice

To drain or not to drain: A meta-analysis on the efficacy of preoperative biliary drainage for tumors causing obstructive jaundice