Abstract：
:Preoperative biliary drainage (PBD) prior to pancreatoduodenectomy (PD) has gained popularity as bridge management to resolve jaundice, but its role is being challenged as it is thought to increase morbidity. To clarify the current recommendations for PBD prior to PD, we reviewed the literature, including all relevant articles published in English up until December, 2015. There is increasing evidence that PBD causes bile infection, which is related to the morbidity of infectious complications. Results of transhepatic drainage are poorer than those of endoscopic stenting, especially in an oncologic setting, although it is still unclear whether metallic stents are superior to nasobiliary drainage. PBD should be avoided whenever possible and performed only in selected cases, such as the emergency setting, an inevitable long delay (>4 weeks) before PD, and jaundice-related anorexia. Seemingly, transhepatic drainage should be reserved for refractory cases if endoscopic drainage is not possible. Further studies comparing endoscopic drainage techniques, such as metallic stents and nasobiliary drainage, are required to assess the most effective technique of PBD. Bile infection should be prevented by adequate antibiotic prophylaxis and treated even in the absence of symptoms, and bile status should be assessed systematically.
journal_name
Surg Todayjournal_title
Surgery todayauthors
Zarzavadjian Le Bian A,Fuks D,Dalla Valle R,Cesaretti M,Violi V,Costi Rdoi
10.1007/s00595-017-1568-9subject
Has Abstractpub_date
2018-04-01 00:00:00pages
371-379issue
4eissn
0941-1291issn
1436-2813pii
10.1007/s00595-017-1568-9journal_volume
48pub_type
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