Document Detail


Meta-analysis of randomized clinical trials on safety and efficacy of biliary drainage before surgery for obstructive jaundice.
MedLine Citation:
PMID:  24264780     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
BACKGROUND: This meta-analysis aimed to investigate whether preoperative biliary drainage (PBD) is beneficial to patients with obstructive jaundice.
METHODS: Data from randomized clinical trials related to safety and effectiveness of PBD versus no PBD were extracted by two independent reviewers. Risk ratios, rate ratios or mean differences were calculated with 95 per cent confidence intervals (c.i.), based on intention-to-treat analysis, whenever possible.
RESULTS: Six trials (four using percutaneous transhepatic biliary drainage and two using endoscopic sphincterotomy) including 520 patients with malignant or benign obstructive jaundice comparing PBD (265 patients) with no PBD (255) were included in this review. All trials had a high risk of bias. There was no significant difference in mortality (risk ratio 1.12, 95 per cent c.i. 0·73 to 1·71; P = 0·60) between the two groups. Overall serious morbidity (grade III or IV, Clavien-Dindo classification) was higher in the PBD group (599 complications per 1000 patients) than in the direct surgery group (361 complications per 1000 patients) (rate ratio 1·66, 95 per cent c.i. 1·28 to 2·16; P < 0·001). Quality of life was not reported in any of the trials. There was no significant difference in length of hospital stay between the two groups: mean difference 4·87 (95 per cent c.i. -1·28 to 11·02) days (P = 0·12).
CONCLUSION: PBD in patients undergoing surgery for obstructive jaundice is associated with similar mortality but increased serious morbidity compared with no PBD. Therefore, PBD should not be used routinely.
Authors:
Y Fang; K S Gurusamy; Q Wang; B R Davidson; H Lin; X Xie; C Wang
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The British journal of surgery     Volume:  100     ISSN:  1365-2168     ISO Abbreviation:  Br J Surg     Publication Date:  2013 Nov 
Date Detail:
Created Date:  2013-11-22     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0372553     Medline TA:  Br J Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  1589-96     Citation Subset:  AIM; IM    
Copyright Information:
© 2013 British Journal of Surgery Society Ltd. Published by John Wiley & Sons Ltd.
Affiliation:
Department of Neurosurgery.
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