The Effects of Different Preoperative Biliary Drainage Methods on Complications Following Pancreaticoduodenectomy

Abstract

The objective of this study was to investigate the effects of different preoperative biliary drainage (PBD) methods on complications in jaundiced patients following pancreaticoduodenectomy. We retrospectively analyzed 270 extrahepatic bile duct cancer patients who underwent pancreaticoduodenectomy. A total of 170 patients without PBD treatment were defined as the non-PBD group. According to different PBD methods, 45, 18, and 37 patients were classified into the percutaneous transhepatic biliary drainage (PTBD), endoscopic nasobiliary drainage (ENBD), and endoscopic retrograde biliary stent (ERBS) groups, respectively. Clinical characteristics and complications were compared among the 4 groups.Preoperative cholangitis occurred in 14 (8.2%) and 8 (21.6%) patients in the non-PBD and ERBS group, respectively (P = 0.04). Compared with the non-PBD group, delayed gastric emptying (DGE) and wound infection occurred significantly more often in the ERBS group. The incidence of severe complications was significantly lower in the PTBD group than the non-PBD group (P = 0.03). Postoperative hospital stay and complication rates were significantly higher in the ERBS group than the PTBD group. There were no significant differences in complications between ENBD and other groups.In conclusion, PTBD can improve surgical outcomes by reducing severe complication rate in jaundiced patients following pancreaticoduodenectomy. ERBS increased the rates of DGE and wound infection due to high incidence of cholangitis before operative intervention and should be avoided. ENBD carried no special effect on complications and needs further analysis.

The safety and efficacy of nasobiliary drainage versus biliary stenting in malignant biliary obstruction

“…Three studies [8–9,11] reported that ENBD decreased the incidence of preoperative cholangitis before standard resection or palliative surgery compared with EBS, while no significant association was reported in 4 studies. [10,12–14] Moderate heterogeneity ( I 2  = 31%, P  = 0.19) was found, so we chose a random-effect model to pool the OR. Overall, the pooled data demonstrated that ENBD was associated with a low incidence of preoperative cholangitis (OR = 0.35, 95% CI = 0.25–0.51, P  < 0.0001) in the MBO patients (Fig.…”

“…Data from 5 articles, [8–10,12–13] including 367 cases in the ENBD group and 381 cases in the EBS group, were used in this meta-analysis. All 5 studies reported that there was no significant difference in the incidence of preoperative pancreatitis between the ENBD and EBS groups.…”

“…Four studies was used to assess morbidity, [8–10,14] which was defined as the incidence of all pre and postoperative complications. Although 3 studies [9,10,14] showed that ENBD had no significant advantage in terms of morbidity compared with EBS, the pooled results had no heterogeneity ( I 2  = 0%, P  = 0.59) and showed that ENBD had a significantly lower incidence of morbidity than EBS (OR = 0.47, 95% CI = 0.27–0.82, P  = 0.008) (Fig.…”

Palliative Surgery for Biliary Drainage in an Unresectable Pancreatic Cancer

“…1,8 The three commonly used methods for achieving preoperative biliary drainage includes endoscopic retrograde biliary stent placement (ERBS), endoscopic nasobiliary drainage (ENBD) and percutaneous transhepatic biliary drainage. 9 The endoscopic positioning of a biliary endoprosthesis has become a relatively easy procedure for experienced endoscopists. Late cholangitis occurred only in case of dislodgement or clogging of the endoprosthesis.…”

“…Huang et al found that PTBD can improve surgical outcomes by reducing severe complication rate in jaundice patients following pancreaticoduodenectomy. 9 In this case, open bilio-digestive bypass was performed instead of preoperative biliary drainage. Whipple procedure (pancreaticoduodenectomy) was not performed, because the tumor size was more than 3 cm and there were metastases to the liver and peritoneum.…”