Effect of preoperative endoscopic biliary drainage on infectious morbidity after pancreatoduodenectomy: a case-control study

TitreEffect of preoperative endoscopic biliary drainage on infectious morbidity after pancreatoduodenectomy: a case-control study
Type de publicationArticle de revue
AuteurLermite, Emilie , Pessaux, Patrick, Teyssedou, Carlos, Etienne, Sandrine, Bréhant, Olivier, Arnaud, Jean-Pierre
EditeurElsevier
TypeArticle scientifique dans une revue à comité de lecture
Année2008
LangueAnglais
Date2008/04
Numéro4
Pagination442 - 446
Volume195
Titre de la revueThe American Journal of Surgery
ISSN0002-9610
Mots-clésBiliary drainage, Infection, Morbidity, Pancreatoduodenectomy
Résumé en anglais

BackgroundThe utility of preoperative endoscopic biliary drainage (PEBD) in jaundiced patients before pancreatoduodenectomy (PD) is still debated. This is in part due to the heterogeneity of the studied population, including different tumor location, drainage techniques, and surgical procedures. The aim of the current study was to report the influence of PEBD on postoperative infectious morbidity of PD. Materials and Methods Between January 1996 and December 2004, 124 patients underwent a PD and 28. Twenty-eight (22.6%) of these patients underwent a PEBD. This group of patients was matched to 28 control patients who underwent PD without PEBD during the same period. The 2 groups were matched for age, sex, indication of surgery, and serum bilirubin levels. Results The specific morbidity of PEBD before surgery was 10.7% (n = 3). The postoperative overall morbidity, medical morbidity, and surgical morbidity rates were not different between the 2 groups. At the time of surgery, 89.3% (n = 25) of the patients in the PEBD group had positive bile culture in comparison to 19.4% (n = 4) in the control group (P < .001). The number of patients with 1 or more infectious complications was higher in the PEBD group (50%; n = 14) than in the control group (21.4%; n = 6) (P = .05). Conclusions Before PD, PEBD should be routinely avoided whenever possible in patients with potentially resectable pancreatic and peripancreatic lesions. In patients with cholangitis, requiring extensive preoperative assessment (such as liver biopsy) or neoadjuvant treatment, PEBD might still be indicated.

URL de la noticehttp://okina.univ-angers.fr/publications/ua3545
DOI10.1016/j.amjsurg.2007.03.016
Lien vers le document

http://dx.doi.org/10.1016/j.amjsurg.2007.03.016