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 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/.

Biliary Drainage Before and After Liver Resection for Perihilar Cholangiocarcinoma

2020 ◽  
Vol 86 (6) ◽  
pp. 628-634
Author(s):  
Laura M. Enomoto ◽  
Matthew E. B. Dixon ◽  
Allene Burdette ◽  
Niraj J. Gusani
Keyword(s):  
Biliary Drainage ◽  
Future Liver Remnant ◽  
Preoperative Biliary Drainage ◽  
Perihilar Cholangiocarcinoma ◽  
Patient Specific ◽  
Liver Remnant ◽  
Biliary Sepsis ◽  
Before And After

Perihilar cholangiocarcinoma (PHC) is a rare tumor that requires surgical resection for a potential cure. The role of preoperative biliary drainage has long been debated, given its treatment of biliary sepsis and decompression of the future liver remnant (FLR), but high procedure-specific morbidity. The indications, methods, and outcomes for preoperative biliary drainage are discussed to serve as a guide for perioperative management of patients with resectable PHC. Multiple studies from the literature related to perihilar cholangiocarcinoma, biliary drainage, and management of the FLR were reviewed. Commonly employed preoperative biliary drainage includes endoscopic biliary stenting and percutaneous transhepatic biliary drainage. Drainage of the FLR remains controversial, with most experts recommending drainage of the only in patients with an FLR <50%. Biliary drainage for resectable PHC requires a patient-specific approach with careful determination of the FLR and balancing of potential morbidity with the benefits of drainage.

scholarly journals Right portal vein versus right portal vein with segment 4 embolization: analysis of impact on future liver remnant volume

HPB ◽  
2018 ◽  
Vol 20 ◽  
pp. S227
Author(s):  
S. Ali ◽  
H. Haq ◽  
J.P.A. Lodge ◽  
G.J. Toogood ◽  
J. Patel ◽  
...  
Keyword(s):  
Portal Vein ◽  
Future Liver Remnant ◽  
Liver Remnant ◽  
Future Liver Remnant Volume ◽  
Liver Remnant Volume

Comparison of Two Methods of Future Liver Remnant Volume Measurement

2007 ◽  
Vol 12 (1) ◽  
pp. 123-128 ◽  
Author(s):  
Yun Shin Chun ◽  
Dario Ribero ◽  
Eddie K. Abdalla ◽  
David C. Madoff ◽  
Melinda M. Mortenson ◽  
...  
Keyword(s):  
Future Liver Remnant ◽  
Volume Measurement ◽  
Liver Remnant ◽  
Future Liver Remnant Volume ◽  
Liver Remnant Volume
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