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

Abstract

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.

The effect of preoperative biliary drainage on postoperative complications of pancreaticoduodenectomy: a triple center retrospective study

“…Regarding postoperative hemorrhage, intraabdominal abscess, POPF, and DGE, our results were similar to a retrospective study conducted at Massachusetts General Hospital, showing no considerable difference between patients who received ERBD and no PBD patients [ 23 ]. Although some studies have reported an increase in postoperative DGE [ 24 , 26 ], we did not observe any significant difference between ERBD and no PBD groups.…”

Changes in activity of metalloproteinases 2 and 9 in rat liver in experimental model of cholestasis taking into account its duration and assessment of selected features

“…Od kilku lat dostępna jest nowa technika drenażu dróg żółciowychdrenaż w asyście endosonografii (endoscopic ultrasound-guided biliary drainage -EUS-BD), który może być korzystną alternatywą dla drenażu przezskórnego [9]. Badania kliniczne wykazały jednak, że mimo normalizacji wyników badań laboratoryjnych u pacjentów z guzami głowy trzustki odsetek powikłań pooperacyjnych po pankreatoduodenektomii poprzedzonej zabiegiem drenażowym nie jest mniejszy niż u pacjentów operowanych z żółtaczką mechaniczną bez drenażu [10,11,12,13,14]. Zakładając, iż przedoperacyjny drenaż dróg żółciowych nie poprawia wyników operacji, pojawia się pytanie, kiedy chorego należy operowaćtak szybko, jak to możliwe, czy po upływie pewnego czasu.…”