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 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/.

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.

scholarly journals The Impact of Preoperative Biliary Drainage on Postoperative Outcomes after Pancreaticoduodenectomy: A Single Center Retrospective Study

2020 ◽  
Author(s):  
Daihai Mo ◽  
Hongyun Ma ◽  
Zhen Wang ◽  
Jiayang Hu ◽  
Gang Li
Keyword(s):  
Gastric Emptying ◽  
Obstructive Jaundice ◽  
Biliary Drainage ◽  
Multivariate Regression ◽  
Delayed Gastric Emptying ◽  
Multivariate Regression Analysis ◽  
Preoperative Biliary Drainage ◽  
Short Term ◽  
Independent Risk Factors ◽  
The Impact

Abstract Background The effect of preoperative biliary drainage (PBD) on the short-term outcomes after pancreaticoduodenectomy (PD) remains controversial. Methods 164 consecutive patients with obstructive jaundice who underwent PD in our center from 2016 to 2017 were retrospectively analyzed. The 120 patients who underwent PBD prior to PD (PBD group) were compared with 44 patients who did not (DS group). The short-term outcomes include overall morbidity, severe complications, postoperative pancreatic fistula(POPF), postpancreatectomy hemorrhage(PPH), intra-abdominal abscess (IAA), sepsis, delayed gastric emptying (DGE), postoperative hospital stay and 90-day death were assesed. Results There were no significant statistical differences in overall morbidity, severe complications, POPF, PPH, IAA, LOS and ninety-day mortality between two groups. The incidence of DGE in PBD group was significantly lower than that in DS group (4.5% vs. 19.2%, P = 0.021). Multivariate regression analysis showed that age over 66 years (OR: 3.094,95% CI: 1.268-7.55) and direct surgery (OR: 5.298, 95% CI: 1.176-23.865) were independent risk factors for DGE. Conclusion For patients with obstructive jaundice, preoperative biliary drainage is independently associated with delayed gastric emptying, but does not affect the overall morbidity and mortality of patients undergoing PD.

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 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 Outcomes of pancreaticoduodenectomy in patients with obstructive jaundice with and without preoperative biliary drainage: a retrospective observational study

2019 ◽  
Vol 12 (5) ◽  
pp. 237-241
Author(s):  
Suvit Sriussadaporn ◽  
Sukanya Sriussadaporn ◽  
Rattaplee Pak-art ◽  
Kritaya Kritayakirana ◽  
Supparerk Prichayudh ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Obstructive Jaundice ◽  
Biliary Drainage ◽  
Surgical Techniques ◽  
Ampulla Of Vater ◽  
Infectious Complications ◽  
Preoperative Biliary Drainage ◽  
Serum Bilirubin Level ◽  
Periampullary Neoplasms ◽  
Chi Squared

Abstract Background Preoperative biliary drainage (PBD) in patients with obstructive jaundice from periampullary neoplasms may reduce the untoward effects of biliary obstruction and subsequent postoperative complications. However, PBD is associated with bile contamination and increases infectious complications after pancreaticoduodenectomy (PD). Objectives To determine whether PBD is associated with more complications after PD. Methods Patients with obstructive jaundice from periampullary lesions who underwent PD from 2000 to 2015 at our institution were retrospectively enrolled. The cohort was divided into a group with PBD and a group without. PBD was performed using one of the following methods: endoprosthesis, percutaneous transhepatic biliary drainage, surgical biliary-enteric bypass, or T-tube choledochostomy. PDs were performed by the first author using uniform surgical techniques. Postoperative complications were recorded. Statistical analyses were conducted using an unpaired t, Fisher exact, or chi-squared tests as appropriate. Results There were 26 with PBD and 28 patients without. Patients in the 2 groups were similar in age, presenting serum bilirubin level, operative time, operative blood transfusion, and hospital stay. The group with PBD had longer duration of jaundice, more patients presenting with cholangitis, and more patients with carcinoma of the ampulla of Vater. The overall complications were higher in patients in the group with PBD than in the group without. Conclusions PBD was associated with more complications overall after PD. However, PBD was necessary and lifesaving in certain clinical situations and improved the condition of patients before they underwent PD. Routine PBD in patients with obstructive jaundice without definite indications is not recommended.

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