Clinical Significances of External Biliary Drainage before Pancreatoduodenectomy in Patients with Obstructive Jaundice

Kohji Konishi, Masahiko Tsuji, Kazuhisa Yabushita, Hisashi Matsumoto, Takao Taniya, Hisashi Hirosawa, Wataru Fukushima, Naotaka Kadoya, Yoshitaka Kuroda, Hiroyuki Sahara

Department of Surgery, Toyama Prefectural Central Hospital

It has been said that surgical intervention in patients with obstructive jaundice should be preceded by biliary decompression such as PTCD (percutaneous transhepatic cholangio-drainage) and ENBD (endoscopic nasogastric biliary drainage) to improve liver function. Some recent reports, however, have suggested that preoperative biliary drainage does not reduce operative morbidity or mortality. In an attempt to assess the efficacy of preoperative PTCD, the clinical records of 163 patients who had been subjected to pancreatoduodenectomy from January 1980 through December 1990 were divided into an icteric group (83 cases), with a preoperative serum bilirubin value greater than 3.0 mg/dl, and a non-icteric group (80 cases), in which this value was below 3.0 mg/dl. The icteric group was further divided into a PTCD group (65 cases) and a non-PTCD group (18 cases). There were no significant differences between the icteric group and the non-icteric group concerning operative time, operative blood loss, postoperative hospital stay, operative mortality or morbidity. Only the preoperative hospital stay in the PTCD group was significantly longer than that of the non-PTCD group. From these results and because of the recent advances in surgical techniques and perioperative patient care, we conclude that patients with obstructive jaundice can undergo a radical operation without preoperative PTCD.

Key words
obstructive jaundice, percutaneous transhepatic cholangio-drainage (PTCD), pancreatoduodenectomy, efficacy of preoperative PTCD

Reprint requests
Kohji Konishi Department of Surgery, Toyama Prefectural Central Hospital
2-2-78 Nishinagae, Toyama, 930 JAPAN

Accepted
September 4, 1991

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