[Value of preoperative drainage of the bile ducts in obstructive jaundice]

Hepato-biliary surgery for obstructive jaundice is associated with high morbidity and mortality rates. Experimental and clinical studies on obstructive jaundice revealed endotoxaemia, coagulation disorders and depressed immune function. Many studies have been carried out to identify the operative risk factors. The serum bilirubin level seemed to be a significant factor. Biliary decompression via a percutaneous or endoscopic retrograde approach was therefore proposed to improve the surgical outcome. The first retrospective studies have suggested a reduction of morbidity and mortality. Subsequent randomized studies have not confirm the benefit of preoperative biliary drainage because of procedure-related complications. The article reviews the literature on preoperative biliary drainage and proposes the indications, choice of method and optimal duration of biliary drainage.