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Efficacy of Preoperative Biliary Tract Decompression in Patients With Obstructive Jaundice

Steven R. Gundry, MD; William E. Strodel, MD; James A. Knol, MD; Frederic E. Eckhauser, MD; Norman W. Thompson, MD
Arch Surg. 1984;119(6):703-708. doi:10.1001/archsurg.1984.01390180065011.
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• Fifty consecutive matched patients with benign or malignant biliary tract obstruction were compared to determine the efficacy of preoperative percutaneous biliary drainage (PBD). Twenty-five patients underwent PBD for an average of nine days before operation; 25 patients underwent percutaneous transhepatic cholangiography (PTHC) followed immediately by operation. Serum bilirubin levels before PTHC were 16.5±7.6 mg/dL and 14.9±7.6 mg/dL in PBD and non-PBD groups, respectively. Serum bilirubin levels decreased to 6.5±6.2 mg/dL preoperatively in patients having PBD. One week after operation, bilirubin levels were 4.2 ±4.3 mg/dL and 9.0±5.2 mg/dL in the PBD and non-PBD groups, respectively. Major morbidity (sepsis, abscess, renal failure, or bleeding) occurred in two patients (8%) having PBD and in 13 patients (52%) without PBD. One patient (4%) with PBD, and five patients (20%) without PBD, died. The mean hospital stay was shorter for the PBD group. Preoperative PBD reduces operative mortality and morbidity and results in a more rapid resolution of hyperbilirubinemia during the postoperative period.

(Arch Surg 1984;119:703-708)

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