Document Detail

Role of preoperative biliary drainage in jaundiced patients who are candidates for pancreatoduodenectomy or hepatic resection: highlights and drawbacks.
MedLine Citation:
PMID:  23013805     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION: In this review of the literature, we analyze the indications for preoperative drainage in jaundiced patients who are candidates for pancreaticoduodenectomy (PD) or major hepatectomy due to periampullary or proximal bile duct neoplasms.
OBJECTIVE: The aim of this study is to review the literature and to report on the current management of jaundiced patients with periampullary or proximal bile duct neoplasms who are candidates for PD or major liver resection.
BACKGROUND: Jaundiced patients represent a major challenge for surgeons. Alterations and functional impairment caused by jaundice increase the risk of surgery; therefore, preoperative biliary decompression has been suggested.
METHODS: A literature review was performed in the MEDLINE database to identify studies on the management of jaundice in patients undergoing PD or liver resection. Papers considering palliative drainage in jaundiced patients were excluded.
RESULTS: The first group of papers considered patients affected by middle-distal obstruction from periampullary neoplasms, in which preoperative drainage was applied selectively. The second group of papers evaluated patients with biliary obstructions from proximal biliary neoplasms. In these cases, Asian authors and a few European authors considered it mandatory to drain the future liver remnant (FLR) in all patients, while American and most European authors indicated preoperative drainage only in selected cases (in malnourished patients and in those with hypoalbuminemia, cholangitis or long-term jaundice; with an FLR < 30% or 40%) given the high risk of complications of drainage (choleperitoneum, cholangitis, bleeding, and seeding). The optimal type of biliary drainage is still a matter of debate; recent studies have indicated that endoscopy is preferable to percutaneous drainage. Although the type of endoscopic biliary drainage has not been clearly established, the choice is made between plastic stents and short, covered, metallic stents, while other authors suggest the use of nasobiliary drainage.
CONCLUSIONS: : 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.
Calogero Iacono; Andrea Ruzzenente; Tommaso Campagnaro; Luca Bortolasi; Alessandro Valdegamberi; Alfredo Guglielmi
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Annals of surgery     Volume:  257     ISSN:  1528-1140     ISO Abbreviation:  Ann. Surg.     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-01-08     Completed Date:  2013-03-05     Revised Date:  2014-04-23    
Medline Journal Info:
Nlm Unique ID:  0372354     Medline TA:  Ann Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  191-204     Citation Subset:  AIM; IM    
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MeSH Terms
Antibiotic Prophylaxis
Bile Duct Neoplasms / complications,  surgery*
Bile Ducts, Intrahepatic
Cholangiocarcinoma / surgery
Cholangitis / prevention & control
Decompression, Surgical / methods*
Jaundice / etiology
Patient Selection
Preoperative Period
Comment In:
Ann Surg. 2014 Apr;259(4):e74-5   [PMID:  24263318 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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