scholarly journals Association of Preoperative Biliary Drainage with Postoperative Morbidity after Pancreaticoduodenectomy

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Chang Liu ◽  
Jian-Wen Lu ◽  
Zhao-Qing Du ◽  
Xue-Min Liu ◽  
Yi Lv ◽  
...  
Keyword(s):  
Bile Duct ◽  
Postoperative Complications ◽  
Obstructive Jaundice ◽  
Wound Infection ◽  
Biliary Drainage ◽  
Postoperative Morbidity ◽  
Preoperative Biliary Drainage ◽  
Matched Pair ◽  
Postoperative Wound ◽  
Significant Difference

Background. The advantages or disadvantages of preoperative biliary drainage (PBD) prior to pancreaticoduodenectomy (PD) remain unclear.Methods. A prospectively maintained database was queried for 335 consecutive patients undergoing standard PD surgery between 2009 and 2013. Clinical data and postoperative complications of the 47 patients receiving PBD and 288 patients with early surgery were compared. A matching analysis was also performed between patients receiving or not receiving PBD (no-PBD).Results. The indication for PBD was severe obstructive jaundice (81%) and cholangitis (26%) at the time of PBD. 47 PBD patients had higher bilirubin level than 288 no-PBD patients preoperatively (363.2 μmol/L versus 136.0 μmol/L,p<0.001). Although no significant difference of any complications could be observed between the two groups, positive intraoperative bile culture and wound infection seemed to be moderately increased in PBD compared to no-PBD patients (p=0.084and 0.183, resp.). In the matched-pair comparison, the incidence of wound infection was three times higher in PBD than no-PBD patients (14.9% versus 4.3%,p=0.080).Conclusions. PBD seems to moderately increase the risk of postoperative wound and bile duct infection. Therefore, PBD should be selectively performed prior to PD.

scholarly journals Effect of Preoperative Internal Biliary Drainage on Postoperative Outcome Following Pancreaticoduodenectomy for Periampullary Carcinoma

KYAMC Journal ◽  
2020 ◽  
Vol 10 (4) ◽  
pp. 196-201
Author(s):  
Munsur Miah ◽  
M Fardil Hossain Faisal ◽  
Bidhan C Das ◽  
Md Manir Hossain Khan ◽  
Md Nahid Reza ◽  
...  
Keyword(s):  
Blood Loss ◽  
Wound Infection ◽  
Biliary Drainage ◽  
Postoperative Morbidity ◽  
Operative Time ◽  
Postoperative Outcome ◽  
Preoperative Biliary Drainage ◽  
Eligibility Criteria ◽  
High Incidence ◽  
Hepatobiliary And Pancreatic Surgery

Background: Preoperative biliary drainage before pancreaticoduodenectomy is a controversial issue. Proponents are in favor of preoperative biliary drainage by ERCP with stent to reduce surgical jaundice with an anticipation of better surgical outcome. Objective: Compare the outcome with or without pre-operative biliary drainage before pancreaticoduodenectomy. Materials and Methods: This observational comparative study was conducted in department of Surgery and Hepatobiliary and pancreatic surgery of BSMMU. Twenty three patients presented with obstructive jaundice due to periampulary carcinoma who subsequently underwent pancreaticoduodenectomy were selected by purposive sampling and finalized by eligibility criteria. Results: Patients with preoperative biliary drainage (PBD) group required a longer operative time (mean 4.12 hours versus 3.83 hours) and had more intra-operative blood loss (mean 662 mL versus 495 mL) compared with non PBD group (P=0.009 and 0.010). No differences were found with respect to operative mortality (4.3%) and incidence of pancreatic leakage (P=0.281). PBD was significantly associated with positive bile culture (P=0.019) and high incidence of wound infection (p=0.029). Conclusion: Preoperative biliary drainage did not increase major postoperative morbidity and mortality but associated with increased operative time, intraoperative blood loss, and incidence of wound infection. Preoperative biliary drainage should be used selectively in patients undergoing pancreaticoduodenectomy. KYAMC Journal Vol. 10, No.-4, January 2020, Page 196-201

scholarly journals The impact of preoperative biliary drainage on postoperative outcomes in patients with malignant obstructive jaundice: a retrospective analysis of 290 consecutive cases at a single medical center

2022 ◽  
Vol 20 (1) ◽  
Author(s):  
Zhihui Gao ◽  
Jie Wang ◽  
Sheng Shen ◽  
Xiaobo Bo ◽  
Tao Suo ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Obstructive Jaundice ◽  
Biliary Drainage ◽  
Medical Center ◽  
Radical Resection ◽  
Preoperative Biliary Drainage ◽  
Malignant Obstructive Jaundice ◽  
Link Type ◽  
Study Population ◽  
The Impact

Abstract Background The efficacy of preoperative biliary drainage (PBD) has been debated for several decades, and yet indications for PBD remain controversial. The aim of this study was to compare the postoperative morbidity and mortality in patients with malignant obstructive jaundice undergoing direct surgery versus surgery with PBD. Methods All consecutive patients with malignant obstructive jaundice who underwent radical resection between June 2017 and December 2019 at Zhongshan Hospital were analyzed retrospectively. The study population was divided into two groups: PBD group (PG) and direct surgery group (DG). The subgroups were chosen based on the site of obstruction. Perioperative indicators and postoperative complications were compared and analyzed. Results A total of 290 patients were analyzed. Postoperative complications occurred in 134 patients (46.4%). Patients in the PG group had a lower overall rate of postoperative complications compared with the DG group, with perioperative total bilirubin (TB) identified as an independent risk factor in multivariate analysis (hazard ratio = 1.004; 95% confidence interval 1.001–1.007; P = 0.017). Subgroup analysis showed that PBD reduced the complication rate in patients with proximal obstruction. In the proximal-obstruction subgroup, a preoperative TB level > 162 μmol/L predicted postoperative complications. Conclusions PBD may reduce the overall rate of postoperative complications among patients with proximal malignant obstructive jaundice. Trial registration ClinicalTrials.gov, 2018ZSLC 24. Registered May 17, 2018, https://clinicaltrials.gov/.

scholarly journals THE SURGICAL BILIO-DIGESTIVE BYPASS BEFORE CEPHALIC PANCREATICODUODENECTOMY, REPORT OF EIGHT CASES

2021 ◽  
Vol 9 (09) ◽  
pp. 840-843
Author(s):  
Mohammed Najih ◽  
◽  
Mohamed Bouzroud ◽  
Aboulfeth El Mehdi ◽  
Bouchentouf Sidi Mohammed ◽  
...  
Keyword(s):  
High Risk ◽  
Postoperative Complications ◽  
Obstructive Jaundice ◽  
Biliary Drainage ◽  
Case Series ◽  
Preoperative Biliary Drainage ◽  
High Morbidity ◽  
Surgical Bypass ◽  
High Bilirubin

The cephalic pancreaticoduodenectomy (CPD) has a universally high morbidity and surgery in patients with obstructive jaundice is associated with a high risk of postoperative complications especially in patients with high bilirubin levels. For this reason, endoscopic preoperative biliary drainage (PBD) has been proposed to improve the postoperative courses.. Nevertheless, this solution is not always feasible and the use of a surgical bilio-digestive bypass may be necessary, which may complicate a later surgical procedure.In this work we report a case series of patients who underwent CPD preceded by a double surgical bypass and we analyze its impact on morbi-mortality.

scholarly journals The Effect of Preoperative Biliary Drainage with or without Pancreatic Stenting on Complications after Pancreatoduodenectomy: A Retrospective Cohort Study

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Jiangtao Chu ◽  
Shun He ◽  
Yan Ke ◽  
Xudong Liu ◽  
Peng Wang ◽  
...  
Keyword(s):  
Cohort Study ◽  
Bile Duct ◽  
Postoperative Complications ◽  
Pancreatic Duct ◽  
Anastomotic Leakage ◽  
Complication Rate ◽  
Biliary Drainage ◽  
Preoperative Biliary Drainage ◽  
Gastrointestinal Dysfunction ◽  
Pancreatic Duct Stenting

Background. The necessity of preoperative biliary drainage (PBD) prior to pancreaticoduodenectomy (PD) is still controversial. However, in some settings, PBD with endoscopic retrograde cholangiopancreatography (ERCP) procedure is recommended as a preferred management. Meanwhile, pancreatic duct stenting in the drainage procedure is rarely performed for selected indications, and its associated complications after PD remain quite unknown. Methods. A retrospective observational longitudinal cohort study was performed on patients who underwent PBD and PD from a prospectively maintained database at the National Cancer Center from March of 2015 to July of 2019. Patients who underwent biliary stenting alone, biliary and pancreatic stenting, were distributed into two study cohort groups, and their records were scrutinized for the incidence of postoperative complications. Results. A total of 83 patients who underwent successful PD after biliary drainage were identified. 29 patients underwent nasobiliary drainage (ENBD)/plastic or metal bile duct stenting (BS) and pancreatic duct stenting (PS group), and 54 patients underwent only ENBD/BS, without pancreatic duct stenting (NPS group). No differences were found between the two groups with respect to in-hospital time, overall complication rate, respective rate of serious (grade 3 or higher) complication rate, bile anastomotic leakage, bleeding, abdominal infection, surgical wound infection, organ dysfunction, and pancreatic anastomotic leakage. Postoperative gastrointestinal dysfunction rates differed significantly, which occurred in 3 (5.56%) cases in the NPS group, compared with 6 (20.7%) cases in the PS group ( P = 0.06 ). In the univariate and multivariate regression model analysis, pancreatic duct stenting was correlated with higher rates of gastrointestinal dysfunction [ odds   ratio   OR = 4.25 , P = 0.0472 ]. Conclusion. Our data suggested that PBD and pancreatic duct stenting prior to pancreatoduodenectomy would increase the risk of postoperative delayed gastric emptying, while the overall incidence of postoperative complications and other complications, such as pancreatic leakage and bile duct leakage, showed no statistical difference.

scholarly journals Comparison of an Inside Stent and a Fully Covered Self-Expandable Metallic Stent as Preoperative Biliary Drainage for Patients with Resectable Perihilar Cholangiocarcinoma Retrospectively.

2021 ◽  
Author(s):  
Hiroshi Mori ◽  
Hiroki Kawashima ◽  
Eizaburo Ohno ◽  
Takuya Ishikawa ◽  
Yasuyuki Mizutani ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Adverse Events ◽  
Pancreatic Fistula ◽  
Biliary Drainage ◽  
Preoperative Biliary Drainage ◽  
Perihilar Cholangiocarcinoma ◽  
Stent Insertion ◽  
Metallic Stent ◽  
Expandable Metallic Stent ◽  
Significant Difference

Abstract BackgroundThere is a need for a more tolerable preoperative biliary drainage (PBD) method for perihilar cholangiocarcinoma (PHCC). In recent years, inside stents (ISs) have attracted attention as a less suffering PBD method. Few studies have compared IS with a fully covered self-expandable metallic stent (FCSEMS) as PBD for resectable PHCC. The aim of this study is to compare them.MethodsThis study involved 87 consecutive patients (IS: 51, FCSEMS: 36). The recurrent biliary obstruction (RBO) rate until undergoing surgery or being diagnosed as unresectable, time to RBO, factors related to RBO, incidence of adverse events related to endoscopic retrograde cholangiography and postoperative complications associated with each stent were evaluated retrospectively.ResultsThere was no significant difference between the two groups in the incidence of adverse events after stent insertion. The mean (s.d.) time to RBO was 40.0 (28.1) days in the IS group and 52.0 (45.5) days in the FCSEMS group, with no significant difference (P=0.384). A total of 7/51 patients in the IS group and 3/36 patients in the FCSEMS group developed RBO. The only risk factor for RBO was bile duct obstruction of the future excisional liver lobe(s) due to stenting (HR 0.033, P=0.006) in the FCSEMS group, but risk factors could not be indicated in the IS group. Regarding postoperative complications, there was no significant difference in the incidence of bile leakage or liver failure. In contrast, pancreatic fistula was significantly more common in the FCSEMS group (13/24 patients) than in the IS group (3/28 patients) (P=0.001), especially in patients who did not undergo pancreatectomy (P=0.001).ConclusionsAs PBD for PHCC, both IS and FCSEMS achieved low RBO rates. In contrast, the incidence of postoperative pancreatic fistula was higher with FCSEMS. Thus, IS, which can be inserted easily, is considered an optimal approach as PBD for resectable PHCC.clinical trial registration number: UMIN000025631

scholarly journals Outcomes of pancreaticoduodenectomy in patients with obstructive jaundice with and without preoperative biliary drainage: a retrospective observational study

2019 ◽  
Vol 12 (5) ◽  
pp. 237-241
Author(s):  
Suvit Sriussadaporn ◽  
Sukanya Sriussadaporn ◽  
Rattaplee Pak-art ◽  
Kritaya Kritayakirana ◽  
Supparerk Prichayudh ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Obstructive Jaundice ◽  
Biliary Drainage ◽  
Surgical Techniques ◽  
Ampulla Of Vater ◽  
Infectious Complications ◽  
Preoperative Biliary Drainage ◽  
Serum Bilirubin Level ◽  
Periampullary Neoplasms ◽  
Chi Squared

Abstract Background Preoperative biliary drainage (PBD) in patients with obstructive jaundice from periampullary neoplasms may reduce the untoward effects of biliary obstruction and subsequent postoperative complications. However, PBD is associated with bile contamination and increases infectious complications after pancreaticoduodenectomy (PD). Objectives To determine whether PBD is associated with more complications after PD. Methods Patients with obstructive jaundice from periampullary lesions who underwent PD from 2000 to 2015 at our institution were retrospectively enrolled. The cohort was divided into a group with PBD and a group without. PBD was performed using one of the following methods: endoprosthesis, percutaneous transhepatic biliary drainage, surgical biliary-enteric bypass, or T-tube choledochostomy. PDs were performed by the first author using uniform surgical techniques. Postoperative complications were recorded. Statistical analyses were conducted using an unpaired t, Fisher exact, or chi-squared tests as appropriate. Results There were 26 with PBD and 28 patients without. Patients in the 2 groups were similar in age, presenting serum bilirubin level, operative time, operative blood transfusion, and hospital stay. The group with PBD had longer duration of jaundice, more patients presenting with cholangitis, and more patients with carcinoma of the ampulla of Vater. The overall complications were higher in patients in the group with PBD than in the group without. Conclusions PBD was associated with more complications overall after PD. However, PBD was necessary and lifesaving in certain clinical situations and improved the condition of patients before they underwent PD. Routine PBD in patients with obstructive jaundice without definite indications is not recommended.

scholarly journals Differentiated approach to the minimally invasive management of malignant obstructive jaundice

2019 ◽  
Vol 24 (2) ◽  
pp. 10-24
Author(s):  
E. I. Galperin ◽  
G. G. Akhaladze ◽  
P. S. Vetshev ◽  
T. G. Dyuzheva
Keyword(s):  
Bile Duct ◽  
Neoadjuvant Chemotherapy ◽  
Obstructive Jaundice ◽  
Biliary Drainage ◽  
Future Liver Remnant ◽  
Preoperative Biliary Drainage ◽  
Malignant Obstructive Jaundice ◽  
Liver Remnant ◽  
Future Liver Remnant Volume ◽  
Liver Remnant Volume

Attitude towards preoperative biliary drainage for malignant obstructive jaundice have recently changed twice. This is due certain factors including complications of minimally invasive biliary drainage, level of bile duct block, cholangitis, need for neoadjuvant chemotherapy, time to scheduled surgery, severe general condition of patient, future liver remnant volume. We comprehensively searched PUBMED, MD Consult and National Library of Medicine using the following keywords: “obstructive jaundice (OJ)”, “cellular immunity”, “preoperative biliary drainage”, “selective biliary drainage”, “distal and proximal bile duct block”, “complications”. Randomized clinical trials and meta-analyzes, opinions of reputable specialists in hepatopancreatobiliary surgery and our own experimental and clinical studies were foreground. The analysis showed that preoperative biliary drainage is not a safe procedure and results an increased number of complications. Absolute indications for preoperative biliary drainage are cholangitis, need for neoadjuvant chemotherapy, increased risk of radical surgery and unresectable tumor. Future liver remnant volume should be considered in patients with portal cholangiocarcinoma followed by proximal block to determine indications for preoperative biliary drainage.

scholarly journals The Impact of Preoperative Biliary Drainage on Postoperative Outcomes of Patients with Malignant Obstructive Jaundice: A Retrospective Analysis of 290 Consecutive Cases at a Single Medical Center

2021 ◽  
Author(s):  
Gao Zhihui ◽  
Wang Jie ◽  
Shen Sheng ◽  
Bo Xiaobo ◽  
Suo Tao ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Obstructive Jaundice ◽  
Biliary Drainage ◽  
Medical Center ◽  
Radical Resection ◽  
Preoperative Biliary Drainage ◽  
Malignant Obstructive Jaundice ◽  
Study Population ◽  
Controversial Topic ◽  
The Impact

Abstract BackgroundThe efficacy of preoperative biliary drainage (PBD) has been debated for several decades, and indications for PBD are still a controversial topic. The aim of this study was to compare the efficacy of PBD among patients with malignant obstructive jaundice in current clinical settings.MethodsAll consecutive patients with malignant obstructive jaundice who underwent radical resection from June 2017 to December 2019 at Zhongshan Hospital were analyzed retrospectively. The study population was divided into two groups: a PBD group (PG) and direct surgery group (DG). Subgroups were chosen by site of obstruction.ResultsA total of 290 patients were analyzed. Postoperative complications occurred in 134 patients (overall rate: 46.4%). Patients in group PG had a lower overall rate of postoperative complications as compared to group DG, with perioperative total bilirubin (TB) identified as an independent risk factor in multivariate analysis (hazard ratio = 1.004; 95% confidence interval 1.001–1.007; P = 0.017). Subgroup analysis showed that PBD reduced the complication rate in patients with proximal obstruction. In the proximal-obstruction subgroup, a preoperative TB level >162 μmol/L predicted postoperative complications.ConclusionsPBD may reduce the overall rate of postoperative complications among patients with proximal obstructive jaundice.Trial registrationClinicalTrials.gov, 2018ZSLC 24. Registered May 17, 2018, https://clinicaltrials.gov/.

scholarly journals POST OPERATIVE WOUND INFECTION

2010 ◽  
Vol 17 (02) ◽  
pp. 174-179
Author(s):  
AAMIR IJAZ ◽  
SUHAIL AMER
Keyword(s):  
Inguinal Hernia ◽  
Hernia Repair ◽  
Antibiotic Prophylaxis ◽  
Wound Infection ◽  
Prophylactic Antibiotics ◽  
Postoperative Wound Infection ◽  
Wound Infections ◽  
Postoperative Wound ◽  
Lichtenstein Hernia Repair ◽  
Significant Difference

Background: The use of antibiotic prophylaxis during Lichtenstein inguinal hernia surgery is controversial, and no definitive guidelines are available in literature. Objective: To determine effects of prophylactic antibiotics in reducing the frequency of postoperative wound infection in Lichtenstein hernia repair. Study Design: Case control study. Setting: Surgical Unit II, Allied Hospital, Faisalabad. Duration: One year, between January 2007 and December 2007. Methods: Patients undergoing unilateral, primary inguinal hernia repairelectively with the Lichtenstein technique using polypropylene mesh were randomized to receive 1.0 g intravenous Cefazolin before the incision or an equal volume of placebo. Wound infection was defined according to the criteria of Centers for Disease Control and recorded. Results were assessed using chi-square test. Results: 100 patients were included in the study. Minimum age of patients in this study was 20 and maximum 75 years with a mean of 44.06 in group A and 44.84 in group B. The total number of wound infections was 7 (7%); 2 (4%) in the antibiotic prophylaxis group and 5 (10%) in the placebo group. Statistical analysis showed no significant difference in the number of wound infections in both groups (p value=0.240). Conclusions: We conclude that in Lichtenstein inguinal hernia repair routine use of prophylactic antibiotics is not needed, as it does not significantly reduce the postoperative wound infection rates.

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