Pancreaticoduodenectomy with preoperative obstructive jaundice: drainage or not.

OBJECTIVES

In this study, we determined whether preoperative biliary drainage should be routinely performed in patients with jaundice.

METHODS

The 342 patients undergoing pancreaticoduodenectomy between June 2004 and June 2008 were analyzed. Of these patients, 303 without biliary drainage were divided into 4 groups: (1) no jaundice, (2) mild jaundice, (3) moderate jaundice, and (4) severe jaundice. Multiple preoperative, intraoperative, and postoperative variables were examined. Postoperative complications were stratified by severity according to the modified Clavien classification.

RESULTS

Patients with jaundice had a higher incidence in subsequent complications than those with no jaundice. The complications were stratified by severity. Compared with those in group 1, patients in groups 2, 3, and 4 had more complications just in grade 2 (15.6%, 23.1%, 28.3%, and 40.0%, respectively, P = 0.046), but not other more severe grades including 3a, 3b, 4a, 4b, and 5; all of the complications in this grade could be conservatively treated and cured without requiring surgical, endoscopic, or radiological intervention. The incidences of infection and overall complications were higher in patients with drainage than those without, but neither difference was statistically significant.

CONCLUSIONS

Preoperative drainage should not routinely be performed in patients with jaundice scheduled for pancreaticoduodenectomy, and immediate surgery is preferable.