Biliary drainage in obstructive jaundice: Experimental and clinical aspects

Abstract

Jaundiced patients undergoing invasive diagnostic and therapeutic procedures are at increased risk of complications and death. Despite the large number of clinical and experimental investigations carried out to identify relevant risk factors, no single parameter has been found to be consistently useful in predicting morbidity or mortality. Biliary decompression was initially employed by surgeons and subsequently by interventional radiologists. More recently, endoscopic retrograde cholangiopancreatography has provided an alternative route for decompression of the biliary tree and preliminary data using this method are encouraging. Although there are enthusiastic proponents of various therapeutic techniques, controlled trials have not been convincing in highlighting the benefits of biliary drainage or in determining the best approach. This article reviews the literature pertaining to this complex surgical problem; an attempt has been made to balance the advantages and disadvantages of biliary decompression as palliation and/or preliminary treatment for extrahepatic biliary obstruction.

Effects of albumin administration in serum liver enzymes of rats in the presence of extrahepatic biliary obstruction

“…The main reported complications are sepsis, haemorrha.ge, renal failure, hypersensitivity to endotoxin, among others 11,12 . Our study using the bile duct ligation as a model of extrahepatic cholestasis, both in the groups treated with albumin as the untreated perrmitiu that the biochemical changes resulting from hepatic cholestasis were evident.…”

Major Liver Resection for Carcinoma in Jaundiced Patients Without Preoperative Biliary Drainage

“…Objectives of PBD before liver resection include improvement of surgical conditions by increasing the tolerance of cholestatic liver to ischemia 19 and decreasing the blood loss, 3,37 and reduction of mortality and morbidity. In our study, there were no significant differences between jaundiced patients and controls for tolerance to hepatic ischemia as assessed by the postoperative rise of aminotransferase levels, despite higher preoperative activity in jaundiced patients.…”

“…2000;135:302-308 L IVER RESECTIONS in jaundiced patients are associated with significant rates of mortality and morbidity, 1,2 resulting mainly from the development of postoperative complications such as sepsis, bleeding, and liver failure. 3,4 Because retrospective reports suggested a direct relationship between serum bilirubin concentration and the risks of operation, 5,6 routine preoperative biliary drainage (PBD) has been advocated before definitive surgery with the aim of reducing morbidity and mortality. Four prospective randomized trials [7][8][9][10] failed to demonstrate a specific benefit of PBD and associated PBD with specific complications that could overcome any apparent benefit.…”

Influence of glutamine on morphological and functional changes of liver in the presence of extrahepatic biliary obstruction in rats

“…Patients with jaundice usually undergo various invasive diagnostic and therapeutic procedures, which is associated with these high rates of complications and deaths. The main reported complications are sepsis, hemorrhage, kidney disorders, hypersensitivity to endotoxin, among others 19,20 . Several experimental and clinical studies have examined the impact of glutamine supplementation in several disease states.…”