Impact of preoperative biliary drainage on pancreaticoduodenectomy complications in periampullary tumors: A case-control study

Abstract

Purpose This study aimed to investigate the effects of preoperative biliary drainage and different preoperative biliary drainage methods in patients with mechanical jaundice who underwent pancreaticoduodenectomy for periampullary tumors. Methods Patients with periampullary tumor with mechanical jaundice who were operated on at the U.U. General Surgery Department between October 2015 and August 2021 were included in this study. The patients were divided into endoscopic biliary drainage, percutaneous transhepatic biliary drainage, and nonpreoperative biliary drainage groups. Patients’ demographic and clinical characteristics were analyzed. Results Of the 173 patients included in the study, 121 underwent preoperative biliary drainage. Of these 121 patients, 32.2% underwent endoscopic biliary drainage. Age, sex, comorbidities, and weight loss were similar in all groups. Cholangitis was the most common complication in the endoscopic biliary drainage and percutaneous transhepatic biliary drainage groups. Postoperative surgical site infection and Clavien‒Dindo ≥ 3b complications were significantly higher in the endoscopic biliary drainage group (P < .001; P = .031, respectively). The length of stay was significantly higher in the endoscopic biliary drainage group (P = .044). Mortality and readmission were similar in all groups. Conclusions Routine preoperative biliary drainage in periampullary tumor with mechanical jaundice does not reduce complications. Percutaneous transhepatic biliary drainage results in a faster decrease in bilirubin and lower infectious complication rates, but it may cause serious technique-related problems.