Role of Preoperative Biliary Drainage in Jaundiced Patients Who Are Candidates for Pancreatoduodenectomy or Hepatic Resection

Abstract

: A multidisciplinary evaluation (made by a surgeon, biliary endoscopist, gastroenterologist, and radiologist) of jaundiced neoplastic patients should be performed before deciding to perform biliary drainage. Middle-distal obstruction in patients who are candidates for PD does not usually require routine biliary drainage. Proximal obstruction in patients who are candidates for major hepatic resection in the majority of cases requires a drain; however, the type, site, number, and approach must be defined and tailored according to the planned hepatic resection. Recently, the use of preoperative biliary drainage limited to the FLR has been a suggested strategy. However, multicenter, randomized, controlled trials should be conducted to clarify this issue.

Influence of cholangitis after preoperative endoscopic biliary drainage on postoperative pancreatic fistula in patients with middle and lower malignant biliary strictures

“…[5][6][7][8] However, in Japan, preoperative biliary drainage is generally carried out. This is attributed to the fact that appropriately conducted preoperative biliary drainage can decrease the risk of postoperative complications 22 and that surgical waiting time, including detailed preoperative examinations, is usually several weeks.…”

“…[5][6][7][8] The development of preoperative cholangitis after preoperative drainage has been reported to increase the incidence of postoperative complications, particularly pancreatic fistula. 9 Pancreatic fistula is a risk factor for surgical site infection.…”

Role of Preoperative Biliary Drainage in Resectable Hilar Cholangiocarcinoma

“…Major drawbacks for ENBD are patient's discomfort and high risk of displacement of the tube. Moreover, the reduction in serum bilirubin is reportedly lower than the other procedures and a longer preoperative hospital stay may be required; also, contemporary drainage of both liver lobes is not achievable with only one tube [20]. Interestingly, Yoshida et al suggested that per-os reintroduction of drained bile may improve immune and hepatic function and overall general status, supporting the hypothesis that bile replacement may be beneficial for patients undergoing major hepatectomy [21].…”

“…In the event of severe complications related to obstructive jaundice, the majority of authors recommend urgent treatment of hyperbilirubinemia, regardless of the origin of the disease; conversely, isolated finding of elevated serum bilirubin may not be per se an indication to perform PBD particularly in the case of malignancies involving the distal portion of common bile duct [20,37,38]. However, as far as HC is concerned, poor evidence is available and data appear discordant.…”

“…Ratti et al [8] showed that percutaneous biliary drainage placement is mandatory in candidates for PVE but also have may advantages in other subsets of patients. In a recent review of the literature, Iacono et al [20] recommend biliary drainage, limited to FLR, in the majority of cases of jaundiced patients who are candidates for major liver resection.…”