Preoperative endoscopic retrograde biliary drainage increases postoperative complications after pancreaticoduodenectomy compared to endoscopic nasobiliary drainage

Han, Seungyeup; Kim, Joo Seop; Hwang, Ji Woong; Kim, Hae Sung

doi:10.21037/gs-20-711

Cited by 4 publications

(5 citation statements)

References 30 publications

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“…Moreover, we performed bile reinfusion combined with enteral nutrition support for patients with external bile drainage, which could avoid the translocation of intestinal flora caused by bile loss and improve the nutritional status of patients. As a result, increased POPF or hemorrhage reported in other researches was not observed in our study ( 46 ). As to patients with high serum bilirubin, the role of PBD remained controversial ( 47 , 48 ).…”

Section: Discussioncontrasting

confidence: 97%

The role of preoperative biliary drainage on postoperative outcome after pancreaticoduodenectomy in patients with obstructive jaundice

Zhu¹,

Yang²,

Cheng³

et al. 2023

Gland Surg

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Background: The role of preoperative biliary drainage (PBD) on obstructive jaundice patients is still controversial. The aim of this retrospective study is to clarify the effect of PBD on postoperative outcomes of pancreaticoduodenectomy (PD) and explore a reasonable PBD strategy for periampullary carcinomas (PAC) patients with obstructive jaundice before surgery.Methods: A total of 148 patients with obstructive jaundice who underwent PD were enrolled in this research and divided into drainage group and no-drainage group according to whether they received PBD. Patients who received PBD were classified into long-term group (>2 weeks) and short-term group (≤2 weeks) according to PBD duration. The clinical data of patients were statistically compared between groups to explore the influence of PBD and its duration. Analysis of pathogens in bile and peritoneal fluid was performed to probe the role of bile pathogens in opportunistic pathogenic bacterial infection after PD.Results: Of all, 98 patients underwent PBD. The mean duration between drainage and surgery was 13 days. Regarding postoperative outcomes, the incidence of postoperative intra-abdominal infection was significantly higher in the drainage group than the no-drainage group (P=0.026). In patients with total bilirubin (TB) less than 250 μmol/L, postoperative intra-abdominal infection was more frequently observed in the drainage group compared to the no-drainage group (P=0.022). Compared to the short-term drainage group, the proportion of positive ascites culture was significantly higher in the long-term drainage group (P=0.022). There were no statistically significant differences in postoperative complications between shortterm group and no-drainage group. The most frequent pathogens detected in bile were Klebsiella pneumoniae, hemolytic Streptococcus and Enterococcus faecalis. The most commonly detected pathogens in peritoneal fluid were Klebsiella pneumoniae, Enterococcus faecalis and Staphylococcus epidermidis which appeared to have a high agreement with pathogens in preoperative bile cultures.Conclusions: Routine PBD should not be performed in obstructive jaundice PAC patients with TB less than 250 μmol/L. For patients with indications for PBD, the drainage duration should be controlled within 2 weeks. Bile bacteria may represent a major source of opportunistic pathogenic bacteria infection after PD.

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Section: Discussioncontrasting

confidence: 97%

The role of preoperative biliary drainage on postoperative outcome after pancreaticoduodenectomy in patients with obstructive jaundice

Zhu¹,

Yang²,

Cheng³

et al. 2023

Gland Surg

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“…But it is noteworthy that there are two distinct differences between LDPPHR-t and PD. First, malignant biliary obstruction is a common problem in patients undergoing PD, but not in patients undergoing LDPPHR-t 39 . Second, the purpose of preoperative ENBD is different.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for achieving textbook outcome after laparoscopic duodenum-preserving total pancreatic head resection: a retrospective cohort study

Wujimaimaiti

Yuan

et al. 2023

International Journal of Surgery

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Introduction: The risk factors for achieving textbook outcome (TO) after laparoscopic duodenum-preserving total pancreatic head resection (LDPPHR-t) are unknown, and no relevant articles have been reported so far. The aim of this study was to identify the risk factors for achieving TO after LDPPHR-t. Methods: The risk factors for achieving TO after LDPPHR-t were retrospectively evaluated by logistic regression analysis in 31 consecutive patients from May 2020 to December 2021. Results: All LDPPHR-t procedures were successfully performed without conversion. There was no death within 90 days after surgery and no readmission within 30 days after discharge. The percentage of achieving TO after LDPPHR-t was 61.3% (19/31). Among the six TO items, the postoperative complication of grade B/C postoperative pancreatic fistula (POPF) occurred most frequently with 22.6%, followed by grade B/C bile leakage with 19.4%, Clavien–Dindo≥III complications with 19.4%, and grade B/C postpancreatectomy hemorrhage with 16.1%. POPF was the major obstacle to achieve TO after LDPPHR-t. Placing an endoscopic nasobiliary drainage (ENBD) catheter and prolonged operation time (>311 min) were significantly associated with the decreased probability of achieving TO after LDPPHR-t (odd ratio (OR), 25.775; P=0.012 and OR, 16.378; P=0.020, respectively). Placing an ENBD catheter was the only significant independent risk factor for POPF after LDPPHR-t (OR, 19.580; P=0.017). Bile leakage was the independent risk factor for postpancreatectomy hemorrhage after LDPPHR-t (OR, 15.754; P=0.040). The prolonged operation time was significantly correlated with Clavien–Dindo grade≥III complications after LDPPHR-t (OR, 19.126; P=0.024). Conclusion: Placing the ENBD catheter was the independent risk factor for POPF and achieving TO after LDPPHR-t. In order to reduce POPF and increase the probability of achieving TO, placing an ENBD catheter should be avoided prior to LDPPHR-t.

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“…PTBD has fewer complications of cholangitis, but the risk of bleeding and tumor metastasis in this method is high. [ 19 20 ]…”

Section: Introductionmentioning

confidence: 99%

Comparing the efficacy and complications of Endoscopic Biliary Drainage (EBD) and Percutaneous Transhepatic Biliary Drainage (PTBD) in patients with perihilar cholangiocarcinoma

Pirayvatlou

Roushan

et al. 2022

J Family Med Prim Care

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A BSTRACT Introduction and Objective: Hilar cholangiocarcinoma (HCCA) is a rare malignancy in patients with biliary disease. If jaundice and obstruction before surgery are left untreated, then they can cause side effects such as cholangitis, delayed tumor treatment, decreased quality of life, and increased mortality. Surgery is the main treatment for HCCA. Therefore, this study was performed to compare the efficacy and complications of percutaneous transhepatic biliary drainage (PTBD) and endoscopic biliary drainage (EBD). Methods: This cohort study was conducted on 20 patients with biliary obstruction who had been selected by simple random sampling and divided into two groups of EBD and PTBD. Three weeks after surgery, patients were compared in terms of bilirubin levels and postoperative complications. Data were analyzed by descriptive statistics (table, mean, and standard deviation) and inferential statistics (independent t-test, Chi-square test, and Fisher’s test). Results: Independent t -test did not show a significant difference between the two groups in terms of bilirubin level ( P = 0.77). However, despite a decrease in bilirubin level in both groups, independent t-test showed that this difference was not significant ( P = 0.08). Fisher’s exact test showed a significant difference between the two groups in terms of postoperative complications ( P = 0.02). Conclusion: Using both drainage methods before surgery reduced bilirubin levels in patients, but EBD method had fewer side effects than PTBD method. The EBD method was performed under the direct supervision of a gastroenterologist. In performing this procedure, specialist physicians should have more supervision.

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Preoperative endoscopic retrograde biliary drainage increases postoperative complications after pancreaticoduodenectomy compared to endoscopic nasobiliary drainage

Cited by 4 publications

References 30 publications

The role of preoperative biliary drainage on postoperative outcome after pancreaticoduodenectomy in patients with obstructive jaundice

The role of preoperative biliary drainage on postoperative outcome after pancreaticoduodenectomy in patients with obstructive jaundice

Risk factors for achieving textbook outcome after laparoscopic duodenum-preserving total pancreatic head resection: a retrospective cohort study

Comparing the efficacy and complications of Endoscopic Biliary Drainage (EBD) and Percutaneous Transhepatic Biliary Drainage (PTBD) in patients with perihilar cholangiocarcinoma

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