Effect of preoperative endoscopic decompression on malignant biliary obstruction and postoperative infection

The role of preoperative biliary drainage as an adjunct in patients undergoing surgical resection for malignant biliary obstruction is controversial. The objective of the present study was to evaluate the effects of preoperative endoscopic biliary drainage and its possible association with postoperative infection in patients presenting neoplastic obstructive jaundice.

The medical records of 53 patients presenting periampullary neoplasia were reviewed. In all of these patients, bile was obtained intraoperatively by puncture. Among the 53 patients, 14 had been submitted to preoperative endoscopic drainage (Group I) and 39 had undergone surgery without decompression (Group II). For statistical analysis, the level of significance was set at 5%.

Bile culture was positive in 13 (92.8%) of the patients in Group I, a significantly higher incidence than that observed in group II, in which 16 (41%) of the patients presented positive cultures (p=0.001). There was no significant difference in general postoperative morbidity between groups (64.2% for group I vs. 46% for group II) or mortality (0% vs. 7.6%, respectively). When infective complications (cholangitis, pneumonia, wall infection) were analyzed separately, a higher incidence, although without significance, was found in Group I than in Group II (50% vs. 28.2%, respectively; p=0.1913).

The presence of an endoscopic biliary drain provokes bacterial colonization, possibly due to the combination of residual cholestasis and duodenal reflux to the bile duct, raising concerns about the possible appearance of infective complications during the postoperative period.