Evaluation Of The Efficacy And Safety Of Preoperative Billary Drainage In Patients With Obstructive Jaundice

Objective To evaluate the effectiveness of preoperative biliary drainage (PBD)in patients with obstructive jaundice resulting from malignant tumors.Methods According to the requirements of Cochrane systematic review, athorough literature search was performed in Medline and Embase electronicdatabases between 1995 and 2009 in terms of the key words preoperative biliarydrainage, restricted articles for the English language. Two reviewers independentlyscreened the studies for eligibility, evaluated the quality and extracted the data fromthe eligible studies with confirmation by cross-checking. Data were processed for ameta-analysis by Stata 9.2 software. Comparison was performed between PBDpatients and patients without PBD, who were both subsequently underwent theresection of the malignant tumors, including the index such as postoperativemortality, the incidence of postoperative pancreatic leakage, bile leakage, abdominalabscess, delayed gastric emptying and incision infection. Twenty-nine consecutivemalignant obstructive jaundiced patients who underwent radical surgery from 2005to June 2009 were retrospectively analyzed for postoperative mortality, complicationincidence, and time of hospital stay, thirteen of which underwent preoperative biliarydrainage.Results According to the selection criteria, 1826 patients with malignantobstructive jaundice from 14 references were selected. There were no statisticalsignificances among postoperative mortality, the incidence of pancreatic leakage andbile leakage, the incidence of abdominal abscess, and the incidence of delayed gastric emptying between PBD patients and patients without PBD (P=0.986, 0.364,0.786, 0.819, 0.265), except the incidence of postoperative incisional infection(P=0.002). Overall postoperative incidence of complications were similar in the twogroups from our hospital (30.8% vs. 18.8%, P=0.37). Length of hospital stay of PBDgroup and NPBD group were 47.46±31.18 days and 25.88±10.60 days,respectively. There was a statistical significance of average length of hospital staybetween two groups (P＜0.05).Conclusion PBD could not significantly reduce incidence of complications andmortality of patients with malignant obstructive jaundice. Therefore, PBD may not beregarded as a preoperative routine measure for the patients with malignant obstructivejaundice.