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What is Appropriate Procedure for Preoperative Biliary Drainage in Patients With Obstructive Jaundice Awaiting Pancreaticoduodenectomy?

Park, Seon-Young MD*; Park, Chang-Hwan MD*; Cho, Sung-Bum MD, PhD*; Lee, Wan-Sik MD, PhD*; Kim, Jung-Chul MD, PhD; Cho, Chul-Kyun MD, PhD; Joo, Young-Eun MD, PhD*; Kim, Hyun-Soo MD, PhD*; Choi, Sung-Kyu MD, PhD*; Rew, Jong-Sun MD, PhD*

Surgical Laparoscopy, Endoscopy & Percutaneous Techniques: October 2011 - Volume 21 - Issue 5 - p 344–348
doi: 10.1097/SLE.0b013e3182318d2f
Original Articles
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Purpose: The aims of this study were to compare the clinical outcomes of the preoperative drainage methods in patients with obstructive jaundice awaiting panreaticoduodenectomy and to determine, which procedure would be more effective for preoperative drainage.

Methods: Among 239 patients undergoing pancreaticoduodenectomy for periampullary cancer, 77 with obstructive jaundice underwent percutaneous transhepatic biliary drainage (PTBD, n=34) or endoscopic biliary drainage (EBD, n=43).

Results: Median rate of decrease in bilirubin was 0.65 mg/d in PTBD group and 0.34 mg/d in EBD group (P=0.003). Median interval from preoperative drainage to pancreaticoduodenectomy were 11 days in PTBD group and 18 days in EBD group (P=0.009). Overall indwelling catheter-related complication rates were higher in “EBD” group compared with “PTBD” group (23.3% vs. 2.9%, P=0.019). No catheter occlusion developed in “PTBD” group, but 6 stent occlusions (13.3%) developed in “EBD” group (P=0.031). The mortality rate was not significantly different between the 2 groups.

Conclusions: Percutaneous biliary drainage may be preferred for preoperative drainage in patients with obstructive jaundice awaiting pancreaticoduodenectomy due to rapid biliary decompression and lower frequency of catheter-related complications.

*Department of Internal Medicine

Department of Hepatobiliary Surgery, Chonnam National University Medical School, Gwangju, South Korea

The authors declare no conflict of interest.

Reprints: Chang-Hwan Park, MD, Department of Internal Medicine, Chonnam National University Medical School, 8 Hak-dong, Dong-ku, Gwangju 501-757, Korea (e-mail: p1052ccy@hanmail.net).

Received January 9, 2011

Accepted August 5, 2011

© 2011 by Lippincott Williams & Wilkins