scholarly journals The Effect of Preoperative Biliary Drainage with or without Pancreatic Stenting on Complications after Pancreatoduodenectomy: A Retrospective Cohort Study

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Jiangtao Chu ◽  
Shun He ◽  
Yan Ke ◽  
Xudong Liu ◽  
Peng Wang ◽  
...  
Keyword(s):  
Cohort Study ◽  
Bile Duct ◽  
Postoperative Complications ◽  
Pancreatic Duct ◽  
Anastomotic Leakage ◽  
Complication Rate ◽  
Biliary Drainage ◽  
Preoperative Biliary Drainage ◽  
Gastrointestinal Dysfunction ◽  
Pancreatic Duct Stenting

Background. The necessity of preoperative biliary drainage (PBD) prior to pancreaticoduodenectomy (PD) is still controversial. However, in some settings, PBD with endoscopic retrograde cholangiopancreatography (ERCP) procedure is recommended as a preferred management. Meanwhile, pancreatic duct stenting in the drainage procedure is rarely performed for selected indications, and its associated complications after PD remain quite unknown. Methods. A retrospective observational longitudinal cohort study was performed on patients who underwent PBD and PD from a prospectively maintained database at the National Cancer Center from March of 2015 to July of 2019. Patients who underwent biliary stenting alone, biliary and pancreatic stenting, were distributed into two study cohort groups, and their records were scrutinized for the incidence of postoperative complications. Results. A total of 83 patients who underwent successful PD after biliary drainage were identified. 29 patients underwent nasobiliary drainage (ENBD)/plastic or metal bile duct stenting (BS) and pancreatic duct stenting (PS group), and 54 patients underwent only ENBD/BS, without pancreatic duct stenting (NPS group). No differences were found between the two groups with respect to in-hospital time, overall complication rate, respective rate of serious (grade 3 or higher) complication rate, bile anastomotic leakage, bleeding, abdominal infection, surgical wound infection, organ dysfunction, and pancreatic anastomotic leakage. Postoperative gastrointestinal dysfunction rates differed significantly, which occurred in 3 (5.56%) cases in the NPS group, compared with 6 (20.7%) cases in the PS group ( P = 0.06 ). In the univariate and multivariate regression model analysis, pancreatic duct stenting was correlated with higher rates of gastrointestinal dysfunction [ odds   ratio   OR = 4.25 , P = 0.0472 ]. Conclusion. Our data suggested that PBD and pancreatic duct stenting prior to pancreatoduodenectomy would increase the risk of postoperative delayed gastric emptying, while the overall incidence of postoperative complications and other complications, such as pancreatic leakage and bile duct leakage, showed no statistical difference.

scholarly journals Association of Preoperative Biliary Drainage with Postoperative Morbidity after Pancreaticoduodenectomy

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Chang Liu ◽  
Jian-Wen Lu ◽  
Zhao-Qing Du ◽  
Xue-Min Liu ◽  
Yi Lv ◽  
...  
Keyword(s):  
Bile Duct ◽  
Postoperative Complications ◽  
Obstructive Jaundice ◽  
Wound Infection ◽  
Biliary Drainage ◽  
Postoperative Morbidity ◽  
Preoperative Biliary Drainage ◽  
Matched Pair ◽  
Postoperative Wound ◽  
Significant Difference

Background. The advantages or disadvantages of preoperative biliary drainage (PBD) prior to pancreaticoduodenectomy (PD) remain unclear.Methods. A prospectively maintained database was queried for 335 consecutive patients undergoing standard PD surgery between 2009 and 2013. Clinical data and postoperative complications of the 47 patients receiving PBD and 288 patients with early surgery were compared. A matching analysis was also performed between patients receiving or not receiving PBD (no-PBD).Results. The indication for PBD was severe obstructive jaundice (81%) and cholangitis (26%) at the time of PBD. 47 PBD patients had higher bilirubin level than 288 no-PBD patients preoperatively (363.2 μmol/L versus 136.0 μmol/L,p<0.001). Although no significant difference of any complications could be observed between the two groups, positive intraoperative bile culture and wound infection seemed to be moderately increased in PBD compared to no-PBD patients (p=0.084and 0.183, resp.). In the matched-pair comparison, the incidence of wound infection was three times higher in PBD than no-PBD patients (14.9% versus 4.3%,p=0.080).Conclusions. PBD seems to moderately increase the risk of postoperative wound and bile duct infection. Therefore, PBD should be selectively performed prior to PD.

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 THE SURGICAL BILIO-DIGESTIVE BYPASS BEFORE CEPHALIC PANCREATICODUODENECTOMY, REPORT OF EIGHT CASES

2021 ◽  
Vol 9 (09) ◽  
pp. 840-843
Author(s):  
Mohammed Najih ◽  
◽  
Mohamed Bouzroud ◽  
Aboulfeth El Mehdi ◽  
Bouchentouf Sidi Mohammed ◽  
...  
Keyword(s):  
High Risk ◽  
Postoperative Complications ◽  
Obstructive Jaundice ◽  
Biliary Drainage ◽  
Case Series ◽  
Preoperative Biliary Drainage ◽  
High Morbidity ◽  
Surgical Bypass ◽  
High Bilirubin

The cephalic pancreaticoduodenectomy (CPD) has a universally high morbidity and surgery in patients with obstructive jaundice is associated with a high risk of postoperative complications especially in patients with high bilirubin levels. For this reason, endoscopic preoperative biliary drainage (PBD) has been proposed to improve the postoperative courses.. Nevertheless, this solution is not always feasible and the use of a surgical bilio-digestive bypass may be necessary, which may complicate a later surgical procedure.In this work we report a case series of patients who underwent CPD preceded by a double surgical bypass and we analyze its impact on morbi-mortality.

Preoperative Biliary Drainage Increases Infectious Complications after Hepatectomy for Proximal Bile Duct Tumor Obstruction

2008 ◽  
Vol 33 (2) ◽  
pp. 318-325 ◽  
Author(s):  
Alessandro Ferrero ◽  
Roberto Lo Tesoriere ◽  
Luca Viganò ◽  
Luisa Caggiano ◽  
Enrico Sgotto ◽  
...  
Keyword(s):  
Bile Duct ◽  
Biliary Drainage ◽  
Infectious Complications ◽  
Preoperative Biliary Drainage ◽  
Bile Duct Tumor ◽  
Proximal Bile Duct

Definition of age dependent reference values for diameter of the common bile duct and pancreatic duct on MRCP from a population based cohort study

Pancreatology ◽  
2018 ◽  
Vol 18 (4) ◽  
pp. S61
Author(s):  
Georg Beyer ◽  
Florian Kasprowicz ◽  
Anke Hannemann ◽  
Ali Aghdassi ◽  
Henry Völzke ◽  
...  
Keyword(s):  
Cohort Study ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Pancreatic Duct ◽  
Reference Values ◽  
Population Based ◽  
Age Dependent ◽  
The Common ◽  
Definition Of

scholarly journals The Effect of Preoperative Biliary and Pancreatic Drainage on Postoperative Pancreatic Fistula: A Retrospective Cohort Study

2018 ◽  
Vol 04 (01) ◽  
pp. e37-e42 ◽  
Author(s):  
John Manipadam ◽  
Mahesh S. ◽  
Jacob Kadamapuzha ◽  
Ramesh H.
Keyword(s):  
Cohort Study ◽  
Pancreatic Fistula ◽  
Biliary Drainage ◽  
Harmful Effect ◽  
Rare Event ◽  
Preoperative Biliary Drainage ◽  
Postoperative Pancreatic Fistula ◽  
Study Cohort ◽  
Biliary Stenting ◽  
Pancreatic Anastomosis

Background Surgeons and endoscopists welcome routine preoperative biliary drainage prior to pancreaticoduodenectomy despite evidence that it increases complications. Its effect on postoperative pancreatic fistula is variably reported in literature. Simultaneous biliary and pancreatic drainage is rarely performed for very selected indications and its effects on postoperative pancreatic fistula are largely unknown. Our aim was to analyze the same while eliminating confounding factors. Methods Retrospective single center cohort study of patients who underwent pancreaticoduodenectomy over the past 10 years for carcinoma obstructing the lower common bile duct. Patients who underwent biliary stenting alone, biliary and pancreatic stenting, and no stenting prior to pancreaticoduodenectomy were the three study cohort groups and their records were scrutinized for the incidence of postoperative pancreatic fistula. Results Sixty-two patients underwent biliary stenting alone, 5 patients underwent both biliary and pancreatic stenting, and 237 patients were not stented in the adenocarcinoma group without chronic pancreatitis. The pancreatic fistula rate was similar in the patients who underwent biliary stenting alone when compared with the group which was not stented. (24/62 versus 67/237, odds ratio [OR] =0.619, confidence interval (CI) =0.345–1.112, p = 0.121). However, the patients who underwent both biliary and pancreatic stenting had a significant increase in postoperative pancreatic fistula compared with the not stented (p = 0.003). By univariate and multivariate analysis using Firth logistic regression, pancreatic texture (OR = 1.205, CI = 0.103–2.476, p = 0.032) and the presence of a biliary and pancreatic stent (OR = 2.695, CI = 0.273–7.617, p = 0.027) were the significant factors affecting pancreatic fistula. Conclusion Preoperative biliary drainage alone has no significant influence on postoperative pancreatic fistula except when combined with pancreatic stenting. We need more such studies from other centers to confirm that the rare event of preoperative biliary and pancreatic stenting has indeed this harmful effect on healing of postoperative pancreatic anastomosis.

scholarly journals Does preoperative pancreatic duct stenting prevent pancreatic fistula after surgery? A cohort study

2008 ◽  
Vol 6 (3) ◽  
pp. 210-213 ◽  
Author(s):  
Tomoyoshi Okamoto ◽  
Takeshi Gocho ◽  
Yasuro Futagawa ◽  
Shuichi Fujioka ◽  
Katsuhiko Yanaga ◽  
...  
Keyword(s):  
Cohort Study ◽  
Pancreatic Fistula ◽  
Pancreatic Duct ◽  
Pancreatic Duct Stenting

scholarly journals The Role of Perioperative Endoscopic Retrograde Cholangiopancreatography and Biliary Drainage in Large Liver Hydatid Cysts

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
A. Krasniqi ◽  
B. Bicaj ◽  
D. Limani ◽  
M. Maxhuni ◽  
A. Rrusta ◽  
...  
Keyword(s):  
Bile Duct ◽  
Complication Rate ◽  
Biliary Drainage ◽  
Tube Placement ◽  
Hydatid Cysts ◽  
Endoscopic Retrograde ◽  
T Tube ◽  
Group I ◽  
Group Ii

Background. The best surgical technique for large liver hydatid cysts (LHCs) has not yet been agreed on. Objectives. The objective of this study was to examine the role of perioperative endoscopic retrograde cholangiopancreatography (ERCP) and biliary drainage in patients with large LHCs. Methods. A 20-year retrospective study of patients with LHCs treated surgically at the University Clinical Center of Kosovo (UCCK). We divided patients into 2 groups based on treatment period: 1981–1990 (Group I) and 2001–2010 (Group II). Demographic characteristics (sex, age), the surgical procedure performed, complications rate, and outcomes were compared. Results. Of the 340 patients in our study, 218 (64.1%) were female with median age of 37 years (range, 17 to 81 years). 71% of patients underwent endocystectomy with partial pericystectomy and omentoplication, 8% total pericystectomy, 18% endocystectomy with capitonnage, and 3% external drainage. In Group I, 10 patients underwent bile duct exploration and T-tube placement; in Group II, 39 patients underwent bile duct exploration and T-tube placement. In addition, 9 patients in Group II underwent perioperative ERCP with papillotomy. The complication rate was 14.32% versus 6.37%, respectively (P=0.001). Conclusion. Perioperative ERCP and biliary drainage significantly decreased the complication rate and improved outcomes in patients with large LHCs.

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