Department of Hepato-pancreatico-biliary Surgery and Liver Transplantation, 525444Shifa International Hospital, Pakistan.
Department of Surgery, 119719Federal Government Polyclinic Hospital, Pakistan.
Surg Innov. 2021 Oct;28(5):567-572. doi: 10.1177/1553350620975887. Epub 2020 Nov 23.
The role of preoperative biliary stenting (PBS) before pancreaticoduodenectomy (PD) in patients with obstructive jaundice is debatable. The objective of the current study was to assess PD outcomes after upfront surgery or PBS and determine the impact of stent to surgery duration on PD outcomes. We reviewed patients who underwent PD between 2011 and 2019. Patients were grouped based on whether they underwent upfront surgery (n = 67) or PBS (n = 66). We further assessed outcomes based on stent to surgery duration. There was no significant difference in 30-day mortality (3% vs. 2.9%, = 1), 90-day mortality (7.5% vs. 4.4%, = .4), and Grade B-C pancreatic fistula rates (7.5% vs. 4.4%, = .4) in the PBS and upfront surgery groups, respectively. A significant increase in wound infections (22.7% vs. 7.4%, = .01) and readmissions (10.6% vs. 0, = .006) was seen in the PBS group. The highest rate of wound infection was seen when stent to surgery duration was 4-6 weeks (41.6%). The wound infection rates in the upfront surgery group, high-risk PBS group (4-6 weeks), and low-risk PBS group were 5/67(7.4%), 5/12(41.6%), and 7/36(19.4%), respectively ( = .008). PBS increases postoperative wound infections when compared with upfront surgery. Patients operated between 4 and 6 weeks after stenting have the highest rate of wound infection.
术前胆道支架置入术（PBS）在伴有梗阻性黄疸的胰十二指肠切除术（PD）中的作用存在争议。本研究旨在评估直接手术或 PBS 后 PD 的结果，并确定支架至手术时间对 PD 结果的影响。
我们回顾了 2011 年至 2019 年间接受 PD 的患者。根据是否进行了直接手术（n = 67）或 PBS（n = 66），将患者分为两组。我们进一步根据支架至手术时间评估了结果。
PBS 组和直接手术组 30 天死亡率（3%与 2.9%， = 1）、90 天死亡率（7.5%与 4.4%， =.4）和 B-C 级胰瘘发生率（7.5%与 4.4%， =.4）均无显著差异。PBS 组的伤口感染（22.7%与 7.4%， =.01）和再入院（10.6%与 0， =.006）显著增加。当支架至手术时间为 4-6 周时，伤口感染率最高（41.6%）。直接手术组、高危 PBS 组（4-6 周）和低危 PBS 组的伤口感染率分别为 5/67（7.4%）、5/12（41.6%）和 7/36（19.4%）（ =.008）。
与直接手术相比，PBS 增加了术后伤口感染。支架置入后 4-6 周手术的患者伤口感染率最高。
