Effect of Preoperative Biliary Drainage on Major Hepatectomy in Rats with Obstructive Jaundice

Hideki Aoki

Department of Surgery I, National Defense Medical College

To determine the effectiveness of preoperative biliary drainage (BD) on major hepatectomy in rats with obstructive jaundice, liver chemistry, plasma endotoxin concentration, energy charge and mitotic index were studied initially in jaundiced rats with or without preoperative BD and sham-operated. At 48 hours after hepatectomy, the energy charge in the group without BD was significantly lower than in the sham-operated group. The mitotic index in the group without BD was significantly lower than in the sham-operated group, and it gradually increased in accordance with the duration of BD. However, bacterial infection appeared to be the problem in the group with BD. Then the effects of bile refeeding during BD on bile flow, mitotic index and bacterial infection before and after hepatectomy were studied. In the bile refed group, bile flow and biliary bilirubin excretion were significantly greater than in the saline fed group and the serum bilirubin concentration just before hepatectomy in the bile refed group was markedly decreased. The mitotic index in the bile refed group was greater than in the saline fed group and it was almost the same as in the sham-operated group. There were no differences in the positive bacterial culture rates in the bile and mesenteric lymph nodes between the bile- and saline-fed groups. These results suggest that preoperative biliary drainage is indispensable for major hepatectomy with obstructive jaundice. And bile refeeding during biliary drainage may play a role in preventing liver failure after hepatectomy with obstructive jaundice.

Key words
obstructive jaundice, biliary drainage, bile refeeding, hepatectomy

Reprint requests
Hideki Aoki The 13th Division Headquarter, Army Surgeon
2-1 Kotobuki, Kaita, Akigun, Hiroshima, 736-0053 JAPAN

Accepted
March 11, 1998

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