Preoperative biliary drainage before resection in obstructive jaundice

BACKGROUND: Surgery for patients with malignant obstructive jaundice carries high morbidity and mortality rates. Preoperative biliary drainage (PBD) has been used in an attempt to improve the outcome in these patients.

AIM: To review the evidence in the literature on whether PBD improves postoperative morbidity and mortality in obstructive jaundice patients. MEHOD: Using Medline a literature search was performed for papers published in English from January 1980 to October 2000, using the text words 'obstructive jaundice', 'preoperative', 'drainage' and 'stent'. All retrieved papers which reported experimental or clinical observations relevant to the study aim were carefully analysed and the findings are summarised in this review.

RESULTS AND CONCLUSION: There is no evidence in the literature to support the view that routine PBD improves postoperative morbidity and mortality in patients with obstructive jaundice undergoing resection. PBD has its own complications that cancel out its benefits. However, PBD could be beneficial in patients presenting with sepsis, coagulation abnormalities or malnutrition.