Preoperative biliary drainage for obstructive jaundice

Wang, Qin; Gurusamy, Kurinchi Selvan; He, Lin; Xie, Xiaohua; Wang, Chaohua

doi:10.1002/14651858.cd005444.pub2

Cited by 93 publications

(81 citation statements)

References 39 publications

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“…Similar finding was also reported by Chalya et al (2011). It has been postulated that definitive surgery to relieve obstructive jaundice plays a greater role in reversing the pathophysiological disturbances associated with obstructive jaundice and thus reduce postoperative morbidity and mortality (Kaushik, 2001;Wang et al, 2008;Afify et al, 2010).…”

Section: Discussionsupporting

confidence: 74%

“…Patients with obstructive jaundice have increased levels of serum bilirubin and most of the complications in the preoperative and postoperative period in obstructive jaundice have been attributed to hyperbilirubinemia (Wang et al, 2008). In the present study, hyperbilirubinemia was found to be associated with poor postoperative outcome in these patients.…”

Section: Discussionsupporting

confidence: 49%

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Predictors of outcome among patients with obstructive jaundice at Bugando Medical Centre in north-western Tanzania

Mabula

Gilyoma

Mchembe

et al. 2014

Tanzania J Hlth Res

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Despite recent advances both in preoperative diagnosis and postoperative care, obstructive jaundice still contributes significantly to high morbidity and mortality. A prospective study was undertaken to identify predictors of outcome among patients with obstructive jaundice at Bugando Medical Centre in north-western Tanzania. A total of 138 patients were studied. The male to female ratio was 1:1.6. The median age of patients was 58 years. Patients with malignant obstructive jaundice were older than those of benign type (P < 0.001). Ca head of pancreas (65.1%) was the commonest malignant cause of jaundice where as choledocholithiasis (51.9%) was the commonest benign cause. Twelve (9.7%) patients were HIV positive with a median CD 4+ count of 342 cells/l. A total of 130 (94.2%) patients underwent surgical treatment and the remaining 8 (5.8%) patients were unfit for surgery. The complication rate was 30.4% mainly due to surgical site infections and it was significantly influenced by malignant causes, WBC count > 10 X 109/l and HIV infection with low CD4 ( 200 cells/l) (p < 0.0001). The median hospital stay and mortality rate were 18 days and 20.3%, respectively. A low haematocrit and presence of postoperative complications were the main predictors of the hospital stay (P < 0.001), whereas age > 60 years, prolonged duration of jaundice, malignant causes, high bilirubin levels, HIV infection with low CD4+ count ( 200 cells/l) and presence of postoperative complications significantly predicted mortality (P< 0.001). In conclusion, our study highlighted the important factors that predict the outcome of patients presenting with obstructive jaundice at BMC; therefore attention should be focused to these factors so as to improve the outcome of these patients.

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Section: Discussionsupporting

confidence: 74%

Section: Discussionsupporting

confidence: 49%

Predictors of outcome among patients with obstructive jaundice at Bugando Medical Centre in north-western Tanzania

Mabula

Gilyoma

Mchembe

et al. 2014

Tanzania J Hlth Res

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“…[5][6][7][8] However, in Japan, preoperative biliary drainage is generally carried out. This is attributed to the fact that appropriately conducted preoperative biliary drainage can decrease the risk of postoperative complications 22 and that surgical waiting time, including detailed preoperative examinations, is usually several weeks.…”

Section: Discussionmentioning

confidence: 99%

Influence of cholangitis after preoperative endoscopic biliary drainage on postoperative pancreatic fistula in patients with middle and lower malignant biliary strictures

Kaneko

Inoue

Kida

et al. 2017

Digestive Endoscopy

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Background and Aim: Preoperative cholangitis after preoperative drainage has been reported to increase postoperative complications, particularly pancreatic fistula. We therefore examined the effects of cholangitis after preoperative endoscopic biliary drainage (EBD) on postoperative pancreatic fistula in patients with middle and lower malignant biliary strictures. Methods:The study group comprised 102 patients who underwent EBD among patients who underwent surgery. Results:Of the 102 patients, 33 (32%) had postoperative pancreatic fistulas, and 56 (55%) had preoperative cholangitis after preoperative drainage. Analysis of risk factors for preoperative cholangitis showed that a total bilirubin level of 2.9 mg/dL or higher (hazard ratio [HR], 2.95; 95% confidence interval [CI], 1.223-7.130; P = 0.016) and a surgical waiting time of 29 days or longer (HR, 4.23; 95% CI, 1.681-10.637; P = 0.02) were independent risk factors for cholangitis. Patients with preoperative cholangitis had a significantly higher incidence of pancreatic fistula than did patients without preoperative cholangitis (78.8 vs 21.2%; P = 0.001). Patients with biliary cancer had a significantly higher incidence of pancreatic fistula than did those with pancreatic cancer (72.7 vs 27.2%; P = 0.005). Multivariate analysis showed that preoperative cholangitis (HR, 4.8; 95% CI,; P = 0.001) and biliary cancer (HR, 3.5; 95% CI, 1.335-8.942; P = 0.006) were significant independent risk factors for postoperative pancreatic fistula.Conclusion: Prevention of preoperative cholangitis, a risk factor for postoperative pancreatic fistula, is likely to decrease the incidence of postoperative pancreatic fistula.

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“…The presence of toxic substances, such as BIL and bile salts, impaired liver function, and altered nutritional status due to obstructive jaundice have been characterized as factors for the development of complications, including acute renal failure, cardiovascular depression, hemorrhage from vitamin K deficiency and septicaemia. 14,15 An obstructed biliary tree is likely to be infected and, as a consequence, there will be a higher incidence of severe chronic cholecystitis found at operation, necessitating conversion. 8 In addition, patients with higher BIL were more likely to undergo an emergency operation, and an emergency operation was a risk factor for poor outcomes.…”

Section: Discussionmentioning

confidence: 99%

Preoperative factors predicting poor outcomes following laparoscopic choledochotomy: a multivariate analysis study

Hong²,

Ni³

et al. 2013

cjs

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Background: Laparoscopic surgery for common bile duct stones varies procedurally from a transcystic approach to laparoscopic choledochotomy (LC) with or without biliary drainage. However, LC is a difficult procedure with higher documented morbidity than the transcystic approach. We retrospectively investigated risk factors for adverse outcomes of LC. Methods:We used logistic regression models to assess 4 categories of adverse outcomes: overall, complications, conversion to open operation and failed surgical clearance. We calculated the area under the receiver operating characteristic curve to evalu ate diagnostic accuracy. Results:We included 201 patients who underwent LC in our analysis. Adverse outcomes occurred in 48 (23.9%) patients, complications occurred in 43 (21.4%), retained stones were observed in 8 (4%), and conversion to laparotomy occurred in 7 (3.5%). Multivariate analysis showed that total bilirubin (BIL) and the presence of medical risk factors (MRFs) were significant predictors of adverse outcomes and complications. We calculated the probability of adverse outcomes (p) using the following formula:According to their logit(p), all patients were divided into a low-risk group (logit(p) ≤ -1.32, n = 130) and a high-risk group (logit(p) > -1.32, n = 71). Patients in the low-risk group had about a 1 in 10 chance (12 of 130) of adverse outcomes developing. Of the 71 patients in the high-risk group, 36 (50.7%) experienced adverse outcomes. Conclusion:High BIL and the presence of MRFs could predict adverse outcomes in patients undergoing LC.Contexte : La chirurgie laparoscopique pour extraction de calculs biliaires logés dans le cholédoque diffère sur le plan technique de la cholédochotomie laparoscopique (CL) par approche transcystique avec ou sans drain biliaire. Toutefois, la CL est une intervention délicate, qui s'accompagne d'un taux de morbidité documenté plus élevé comparativement à l'extraction transcystique. Nous avons analysé rétrospectivement les facteurs de risque à l'égard d'une issue négative de la CL.Méthodes : Nous avons utilisé des modèles de régression logistique pour évaluer 4 catégories d'issue négative : issue négative globale, complications, conversion vers une chirurgie ouverte et échec de l'extraction chirurgicale. Nous avons calculé l'aire sous la courbe de la fonction d'efficacité du récepteur pour évaluer la précision diagnostique.Résultats : Nous avons inclus dans notre analyse 201 patients soumis à une CL. Une issue négative est survenue chez 48 patients (23,9 %), des complications chez 43 (21,4 %), la persistance des calculs chez 8 (4 %) et la conversion vers la laparotomie chez 7 (3,5 %). L'analyse multivariée a montré que la bilirubine totale ( Conclusion : Un taux de BIL élevé et la présence de FRM pourraient prédire l'issue négative chez des patients soumis à une CL.

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Preoperative biliary drainage for obstructive jaundice

Cited by 93 publications

References 39 publications

Predictors of outcome among patients with obstructive jaundice at Bugando Medical Centre in north-western Tanzania

Predictors of outcome among patients with obstructive jaundice at Bugando Medical Centre in north-western Tanzania

Influence of cholangitis after preoperative endoscopic biliary drainage on postoperative pancreatic fistula in patients with middle and lower malignant biliary strictures

Preoperative factors predicting poor outcomes following laparoscopic choledochotomy: a multivariate analysis study

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