Preoperative biliary drainage does not increase major complications in pancreaticoduodenectomy: A large single center experience from the Massachusetts General Hospital

Abstract

Background The impact of preoperative biliary drainage (PBD) on perioperative morbidity and mortality in pancreatic surgery is still under debate. The aim of this study was to investigate outcomes of stented vs. non-stented patients undergoing pancreatoduodenectomy (PD). Methods We retrospectively compared 500 consecutive patients who underwent PBD prior to PD with 500 patients who did not. Ninety-day mortality and morbidity were assessed. Results The overall postoperative morbidity and mortality was 37% and 1.4%, respectively. Major complications (Clavien ≥ III) occurred in 16% of patients. The overall morbidity and mortality was not significantly higher in patients who underwent PBD. However, the rate of wound infection was significantly higher in patients who underwent PBD (19% vs. 9%, P = 0.001). When comparing intraoperative bile cultures of stented patients with and without wound infection, the presence of Enterobacter species (OR 2.4, 95% CI 1.5-4.1, P = 0.001) and Citrobacter species (OR 2.3, 95% CI 1.1-5.2, P = 0.037) in the bile significantly increased the likelihood of wound infection. Conclusion Preoperative biliary drainage is associated with bactobilia and wound infection, but does not affect the overall morbidity and mortality of patients undergoing PD. Highlight To clarify the controversial impact of preoperative biliary drainage on perioperative morbidity and mortality in patients undergoing pancreaticoduodenectomy, Sahora and colleagues compared the outcomes of 500 stented and 500 non-stented patients. Although preoperative biliary drainage was associated with bactobilia and wound infection, it did not affect overall morbidity and mortality.