Surgical outcome after pancreatoduodenectomy: effect of preoperative biliary drainage

Depth of jaundice has been associated with increased risk of complications following operations. The value of preoperative biliary drainage has already been studied with contradictory results. In the present analysis we tried to determine the association between preoperative biliary drainage and postoperative complications in a nonselected series of patients.

Patients, who have undergone duodenopancreatectomy for periampullary adenocarcinoma, were included in the study. Patient data consisted of age, gender, diabetes mellitus, preoperative risk assessment according to ASA, preoperative biliary drainage, preoperative bilirubin level, operative time, type of duodenopancreatectomy, postoperative morbidity and mortality. Mann-Whitney exact test, Fisher's exact test and logistic-regression model were used for statistical analysis.

Inclusion criteria for the study met 87 patients operated on from January 1996 till January 2000. Preoperative biliary drainage was not associated with mortality, rate of reoperation or length of hospital stay. Morbidity in these patients was slightly higher comparing to patients, who were not preoperatively drained, but this difference was not statistically important (p=0.3). In multivariate analysis, duration of operation was statistically the most significant predictor for postoperative complications (p=0.03).

In patients with a resectable periampullary mass and obstructive jaundice, preoperative biliary drainage is not warranted. It may even be associated with increased risk of postoperative infectious complications. Biliary drainage should be done only in patients, who are not candidates for resection.