The abnormal lipid spectrum in malignant obstructive jaundice in relation to endotoxin sensitivity and the result of preoperative biliary drainage

Surgery ◽  
2001 ◽  
Vol 129 (3) ◽  
pp. 282-291 ◽  
Author(s):  
Nikola Kimmings ◽  
Miguel E. Sewnath ◽  
Willem M. Mairuhu ◽  
Anton P. van Zanten ◽  
Erik A.J. Rauws ◽  
...  
Keyword(s):  
Obstructive Jaundice ◽  
Biliary Drainage ◽  
Preoperative Biliary Drainage ◽  
Malignant Obstructive Jaundice ◽  
Lipid Spectrum

scholarly journals 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

2022 ◽  
Vol 20 (1) ◽  
Author(s):  
Zhihui Gao ◽  
Jie Wang ◽  
Sheng Shen ◽  
Xiaobo Bo ◽  
Tao Suo ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Obstructive Jaundice ◽  
Biliary Drainage ◽  
Medical Center ◽  
Radical Resection ◽  
Preoperative Biliary Drainage ◽  
Malignant Obstructive Jaundice ◽  
Link Type ◽  
Study Population ◽  
The Impact

Abstract Background The 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. Methods All 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. Results A 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. Conclusions PBD may reduce the overall rate of postoperative complications among patients with proximal malignant obstructive jaundice. Trial registration ClinicalTrials.gov, 2018ZSLC 24. Registered May 17, 2018, https://clinicaltrials.gov/.

scholarly journals Differentiated approach to the minimally invasive management of malignant obstructive jaundice

2019 ◽  
Vol 24 (2) ◽  
pp. 10-24
Author(s):  
E. I. Galperin ◽  
G. G. Akhaladze ◽  
P. S. Vetshev ◽  
T. G. Dyuzheva
Keyword(s):  
Bile Duct ◽  
Neoadjuvant Chemotherapy ◽  
Obstructive Jaundice ◽  
Biliary Drainage ◽  
Future Liver Remnant ◽  
Preoperative Biliary Drainage ◽  
Malignant Obstructive Jaundice ◽  
Liver Remnant ◽  
Future Liver Remnant Volume ◽  
Liver Remnant Volume

Attitude towards preoperative biliary drainage for malignant obstructive jaundice have recently changed twice. This is due certain factors including complications of minimally invasive biliary drainage, level of bile duct block, cholangitis, need for neoadjuvant chemotherapy, time to scheduled surgery, severe general condition of patient, future liver remnant volume. We comprehensively searched PUBMED, MD Consult and National Library of Medicine using the following keywords: “obstructive jaundice (OJ)”, “cellular immunity”, “preoperative biliary drainage”, “selective biliary drainage”, “distal and proximal bile duct block”, “complications”. Randomized clinical trials and meta-analyzes, opinions of reputable specialists in hepatopancreatobiliary surgery and our own experimental and clinical studies were foreground. The analysis showed that preoperative biliary drainage is not a safe procedure and results an increased number of complications. Absolute indications for preoperative biliary drainage are cholangitis, need for neoadjuvant chemotherapy, increased risk of radical surgery and unresectable tumor. Future liver remnant volume should be considered in patients with portal cholangiocarcinoma followed by proximal block to determine indications for preoperative biliary drainage.

scholarly journals The Impact of Preoperative Biliary Drainage on Postoperative Outcomes of Patients with Malignant Obstructive Jaundice: A Retrospective Analysis of 290 Consecutive Cases at a Single Medical Center

2021 ◽  
Author(s):  
Gao Zhihui ◽  
Wang Jie ◽  
Shen Sheng ◽  
Bo Xiaobo ◽  
Suo Tao ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Obstructive Jaundice ◽  
Biliary Drainage ◽  
Medical Center ◽  
Radical Resection ◽  
Preoperative Biliary Drainage ◽  
Malignant Obstructive Jaundice ◽  
Study Population ◽  
Controversial Topic ◽  
The Impact

Abstract BackgroundThe efficacy of preoperative biliary drainage (PBD) has been debated for several decades, and indications for PBD are still a controversial topic. The aim of this study was to compare the efficacy of PBD among patients with malignant obstructive jaundice in current clinical settings.MethodsAll consecutive patients with malignant obstructive jaundice who underwent radical resection from June 2017 to December 2019 at Zhongshan Hospital were analyzed retrospectively. The study population was divided into two groups: a PBD group (PG) and direct surgery group (DG). Subgroups were chosen by site of obstruction.ResultsA total of 290 patients were analyzed. Postoperative complications occurred in 134 patients (overall rate: 46.4%). Patients in group PG had a lower overall rate of postoperative complications as compared to group DG, 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 obstructive jaundice.Trial registrationClinicalTrials.gov, 2018ZSLC 24. Registered May 17, 2018, https://clinicaltrials.gov/.

Percutaneous Transhepatic Biliary Drainage in Malignant Obstructive Jaundice

1983 ◽  
Vol 69 (2) ◽  
pp. 161-165 ◽  
Author(s):  
Aldo Severini ◽  
Guido Cozzi ◽  
Massimo Bellomi ◽  
Maria Chiara Castoldi ◽  
Roberto Doci
Keyword(s):  
Prognostic Factors ◽  
Surgical Treatment ◽  
Liver Function ◽  
Obstructive Jaundice ◽  
Biliary Drainage ◽  
Biliary Obstruction ◽  
Percutaneous Transhepatic Biliary Drainage ◽  
Malignant Obstructive Jaundice ◽  
High Operative Risk ◽  
Transhepatic Biliary Drainage

Results obtained in 70 patients with neoplastic (primary or metastatic) biliary obstruction and submitted to percutaneous transhepatic biliary drainage indicate the effectiveness of the technique in relieving jaundice, improving general conditions and restoring liver function. In 25.4% of cases, the drainage allowed the patients to undergo surgical treatment of the neoplasm. In 74.6%, the drainage was left in place as definitive palliation. The complication rate was very low and similar to that described in the literature. At this time it is difficult to identify prognostic factors and foresee the results of percutaneous transhepatic biliary drainage, but the procedure is always indicated in patients at high operative risk or inoperable.

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