Surgery, Gastroenterology and Oncology

Background: The value of preoperative biliary drainage (PBD) on the surgical outcome after pancreaticoduodenectomy (PD) is still a point of controversy.The aim of this study was to identify the impact of biliary drainage (BD) prior to PD on the postoperative outcome.
Methods: The data of patients, who underwent PD from February 2009 to February 2017, were retrospectively studied. A comparison was performed between 2 groups of patients; group A (with PBD) and group B (without PBD), according to preoperative, operative and postoperative data.
Results: PD was performed in 158 patients with periampullary lesions. Group A, included 76 patients (48.1%) while 82 patients were included in group B (51.9%).
The incidence of major postoperative complications was significantly higher in group A (P=0.04). The infectious complications were higher in group like; positive intraoperative bile culture (P=0.06), intraabdominal abscess (P=0.07) and wound infection (P=0.04).
Also, hospital stay and mortality were higher in group A (P=0.05 and 0.08, respectively).
High preoperative bilirubin level was not a risk factor for major postoperative complications (P=0.12).

Conclusion: Patients with PBD had a significantly higher incidence of major postoperative complications mainly of infectious ones, thus PBD should be performed only in selected patients, not as a routine prior PD.

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