Pre-operative biliary drainage for obstructive jaundice
Yuan Fang1, Kurinchi Selvan Gurusamy, Qin Wang
1Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China.
The Cochrane Database of Systematic Reviews
|September 14, 2012
Summary
Pre-operative biliary drainage for obstructive jaundice does not significantly impact mortality but may increase serious adverse events. Routine use is not recommended due to insufficient evidence and potential harm.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Hepatology
Background:
- Obstructive jaundice causes systemic pathophysiological changes affecting multiple organs.
- The benefit of pre-operative biliary drainage (PBD) before major surgery for obstructive jaundice remains controversial.
Purpose of the Study:
- To evaluate the benefits and harms of PBD compared to direct surgery in patients with obstructive jaundice.
Main Methods:
- Systematic review of randomized clinical trials comparing PBD followed by surgery versus direct surgery.
- Searched multiple databases including Cochrane, MEDLINE, and EMBASE until February 2012.
- Assessed risk of bias and used trial sequential analysis to evaluate the certainty of evidence.
Main Results:
- Six trials with 520 patients were included; high risk of bias was noted across all trials.
- No significant difference in mortality was observed between PBD and direct surgery groups.
- Serious morbidity was significantly higher in the PBD group (73.5%) compared to the direct surgery group (37.4%).
Conclusions:
- Insufficient evidence exists to support or refute routine PBD for obstructive jaundice.
- PBD may increase the risk of serious adverse events, and its safety is not established.
- PBD should not be routinely used outside of randomized clinical trials.
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