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Titolo:
The effect of preoperative biliary drainage on postoperative complicationsafter pancreaticoduodenectomy
Autore:
Sewnath, ME; Birjmohun, RS; Rauws, EAJ; Huibregtse, K; Obertop, H; Gouma, DJ;
Indirizzi:
Univ Amsterdam, Acad Med Ctr, Dept Surg, NL-1100 DD Amsterdam, NetherlandsUniv Amsterdam Amsterdam Netherlands NL-1100 DD D Amsterdam, Netherlands Univ Amsterdam, Acad Med Ctr, Dept Gastroenterol, NL-1100 DD Amsterdam, Netherlands Univ Amsterdam Amsterdam Netherlands NL-1100 DD D Amsterdam, Netherlands
Titolo Testata:
JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS
fascicolo: 6, volume: 192, anno: 2001,
pagine: 726 - 734
SICI:
1072-7515(200106)192:6<726:TEOPBD>2.0.ZU;2-B
Fonte:
ISI
Lingua:
ENG
Soggetto:
MALIGNANT OBSTRUCTIVE-JAUNDICE; EXTRAHEPATIC BILE-DUCTS; CELL-MEDIATED-IMMUNITY; TRANS-HEPATIC DRAINAGE; PANCREATIC HEAD; RANDOMIZED TRIAL; DECOMPRESSION; RATS; MORTALITY; TUMORS;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
51
Recensione:
Indirizzi per estratti:
Indirizzo: Gouma, DJ Univ Amsterdam, Acad Med Ctr, Dept Surg, POB 22660, NL-1100 DD Amsterdam, Netherlands Univ Amsterdam POB 22660 Amsterdam Netherlands NL-1100 DD lands
Citazione:
M.E. Sewnath et al., "The effect of preoperative biliary drainage on postoperative complicationsafter pancreaticoduodenectomy", J AM COLL S, 192(6), 2001, pp. 726-734

Abstract

BACKGROUND: The benefit of preoperative biliary drainage in jaundiced patients undergoing pancrearicoduodenectomy for a suspected malignancy of the periampullary region is still under debate. This study evaluated preoperative biliary drainage in relation to postoperative outcomes. STUDY DESIGN: At the Academic Medical Center, Amsterdam, the Netherlands, a cohort of 311 patients undergoing pancreaticoduodenectomy from June 1992 up to and including December 1999 was studied. Of this cohort 21 patients with external or surgical biliary drainage were excluded and 232 patients who had received preoperative internal biliary drainage were divided into three groups corresponding with severity of jaundice according to preoperativeplasma bilirubin levels: <40 <mu>M (n = 177), 40 to 100 muM (n = 32), and > 100 muM (n = 23) were designated as groups 1, 2, and 3, respectively. These groups were compared with patients who underwent immediate surgery (n = 58) without preoperative drainage. RESULTS: The median number of stent (re)placements was 2 (range 1 to 6) with a median drainage duration of 41 days (range 2 to 182 days) and a stent dysfunction rate of 33%. Although patients in group 1 were better drained than patients in groups 2 and 3 (median reduction of bilirubin levels 82%, 57%, and 37%, respectively, p < 0.01), there was no difference in overall morbidity among the drained groups (50%, 50%, and 52%, respectively). There was no significant difference in overall morbidity between patients with andwithout preoperative biliary drainage (50% and 55%, respectively). CONCLUSIONS: Preoperative biliary drainage did not influence the incidenceof postoperative complications, and although it can be performed safely injaundiced patients it should not be used routinely. (J Am Coll Surg 2001;192:726-734. (C) 2001 by the American College of Surgeons).

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 03/04/20 alle ore 11:13:45