World Journal of Surgery

, Volume 33, Issue 2, pp 318–325 | Cite as

Preoperative Biliary Drainage Increases Infectious Complications after Hepatectomy for Proximal Bile Duct Tumor Obstruction

  • Alessandro Ferrero
  • Roberto Lo Tesoriere
  • Luca Viganò
  • Luisa Caggiano
  • Enrico Sgotto
  • Lorenzo Capussotti



The role of preoperative biliary drainage before liver resection in jaundiced patients remains controversial. The objective of this study is to compare the perioperative outcome of liver resection for carcinoma involving the proximal bile duct in jaundiced patients with and without preoperative biliary drainage.


Seventy-four consecutive jaundiced patients underwent hepatectomy for carcinoma involving the proximal bile duct from January 1989 to June 2006 and their data were retrospectively analyzed. Fourteen patients underwent biliary drainage before portal vein embolization and were excluded from the study. Thirty patients underwent biliary drainage before hepatectomy and 30 underwent liver resection without preoperative biliary drainage. All patients underwent resection of the extrahepatic bile duct.


Overall mortality and operative morbidity were similar in the two groups (3% vs. 10%, p = 0.612 and 70% vs. 63%, p = 0.583, respectively). The incidence of noninfectious complications was similar in the two groups. There was no difference in hospital stay between the two groups. Patients with preoperative biliary drainage had a significantly higher rate of infectious complications (40% vs. 17%, p = 0.044). At multivariate analysis, preoperative biliary drainage was the only independent risk factor for infectious complication in the postoperative course (RR = 4.411, 95%CI = 1.216-16.002, p = 0.024). Even considering patients with preoperative biliary drainage in whom the bilirubin level went below 5 mg/dl, the risk of infectious complications was higher compared with patients without biliary drainage (47.6% vs. 16.6%, p = 0.017).


Overall mortality and morbidity after liver resection are not improved by preoperative biliary drainage in jaundiced patients. Prehepatectomy biliary drainage increases the incidence of infectious complications.


  1. 1.
    Lai EC, Chu KM, Lo CY et al (1992) Surgery for malignant obstructive jaundice: analysis of mortality. Surgery 112:891–896PubMedGoogle Scholar
  2. 2.
    Su CH, P’eng FK, Lui WY (1992) Factors affecting morbidity and mortality in biliary tract surgery. World J Surg 16:536–540PubMedCrossRefGoogle Scholar
  3. 3.
    Dixon JM, Armstrong CP, Duffy SW et al (1984) Factors affecting mortality and morbidity after surgery for obstructive jaundice. Gut 25:104PubMedCrossRefGoogle Scholar
  4. 4.
    Kawarada Y, Higashiguchi T, Yokoi H et al (1995) Preoperative biliary drainage in obstructive jaundice. Hepatogastroenterology 42:300–307PubMedGoogle Scholar
  5. 5.
    Sewnath ME, Karsten TM, Prins et al (2002) A meta-analysis on the efficacy of preoperative biliary drainage for tumors causing obstructive jaundice. Ann Surg 236:17–27Google Scholar
  6. 6.
    The Brisbane 2000 Terminology of Liver Anatomy and Resection (2000) Terminology Committee of the International Hepato-Pancreato-Biliary Association. HPB 2:333–339Google Scholar
  7. 7.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–513PubMedCrossRefGoogle Scholar
  8. 8.
    Capussotti L, Ferrero A, Viganò L et al (2006) Bile leakage and liver resection: Where is the risk? Arch Surg 141:690–694PubMedCrossRefGoogle Scholar
  9. 9.
    Gouma DJ, Coelho JC, Schlegel JF et al (1987) The effect of preoperative internal and external biliary drainage on mortality of jaundiced rats. Arch Surg 122:731–734PubMedGoogle Scholar
  10. 10.
    Saiki S, Chijiiwa K, Komura M et al (1999) Preoperative internal biliary drainage is superior to external biliary drainage in liver regeneration and function after hepatectomy in obstructive jaundiced rats. Ann Surg 230:655–662PubMedCrossRefGoogle Scholar
  11. 11.
    Vauthey JN, Blumgart LH (1994) Recent advances in the management of cholangiocarcinomas. Semin Liver Dis 14:109–114PubMedCrossRefGoogle Scholar
  12. 12.
    Clements WD, Diamond T, McCrory DC et al (1993) Biliary drainage in obstructive jaundice: experimental and clinical aspects. Br J Surg 80:834–842PubMedCrossRefGoogle Scholar
  13. 13.
    Pitt HA, Gomes AS, Lois JF et al (1985) Does preoperative percutaneous biliary drainage reduce operative risk or increase hospital cost? Ann Surg 201:545–553PubMedCrossRefGoogle Scholar
  14. 14.
    McPherson GA, Benjamin IS, Hodgson HJ et al (1984) Pre-operative percutaneous transhepatic biliary drainage: the results of a controlled trial. Ann Surg 71:371–5Google Scholar
  15. 15.
    Hatfield AR, Tobias R, Terblanche J et al (1982) Preoperative external biliary drainage in obstructive jaundice. A prospective controlled clinical trial. Lancet 2:896–899PubMedCrossRefGoogle Scholar
  16. 16.
    Lai EC, Mok FP, Fan ST et al (1994) Preoperative endoscopic drainage for malignant obstructive jaundice. Br J Surg 81:1195–1198PubMedCrossRefGoogle Scholar
  17. 17.
    Nimura Y, Naokazu H, Kamiya J et al (1990) Hepatic segmentectomy with caudate lobe resection for bile duct carcinoma of the hepatic hilus. World J Surg 14:534–544CrossRefGoogle Scholar
  18. 18.
    Sano T, Shimada K, Sakamoto Y et al (2006) One hundred two consecutive hepatobiliary resections for perihilar cholangiocarcinoma with zero mortality. Ann Surg 244:240–247PubMedCrossRefGoogle Scholar
  19. 19.
    Seyama Y, Kubota K, Sano K et al (2003) Long-term outcome of extended hemihepatectomy for hilar bile duct cancer with no mortality and high survival rate. Ann Surg 238:73–83PubMedCrossRefGoogle Scholar
  20. 20.
    Cherqui D, Benoist S, Malassagne B et al (2000) Major liver resection for carcinoma in jaundiced patients without preoperative biliary drainage. Arch Surg 135:302–308PubMedCrossRefGoogle Scholar
  21. 21.
    Liu CL, Lo CM, Lai EC et al (1998) Endoscopic retrograde cholangiopancreatography and endoscopic endoprosthesis insertion in patients with Klatskin tumors. Arch Surg 133:293–296PubMedCrossRefGoogle Scholar
  22. 22.
    Polydorou AA, Cairns SR, Dowsett JF et al (1991) Palliation of proximal malignant biliary obstruction by endoscopic endoprosthesis insertion. Gut 32:685–689PubMedCrossRefGoogle Scholar
  23. 23.
    Ferrucci JT Jr, Mueller PR, Harbin WP (1980) Percutaneous transhepatic biliary drainage: technique, results, and applications. Radiology 135:1–13PubMedGoogle Scholar
  24. 24.
    Yee AC, Ho CS (1987) Complications of percutaneous biliary drainage: benign vs malignant diseases. AJR Am J Roentgenol 148:1207–1209PubMedGoogle Scholar
  25. 25.
    Mueller PR, van Sonnenberg E, Ferrucci JT Jr (1982) Percutaneous biliary drainage: technical and catheter-related problems in 200 procedures. AJR Am J Roentgenol 138:17–23PubMedGoogle Scholar
  26. 26.
    Ishizawa T, Hasegawa K, Sano K et al (2007) Selective versus total biliary drainage for obstructive jaundice caused by a hepatobiliary malignancy. Am J Surg 193:149–154PubMedCrossRefGoogle Scholar
  27. 27.
    Hochwald SN, Burke EC, Jarnagin WR et al (1999) Association of preoperative biliary stenting with increased postoperative infectious complications in proximal cholangiocarcinoma. Arch Surg 134:261–266PubMedCrossRefGoogle Scholar
  28. 28.
    Karsten TM, Allema JH, Reinders M et al (1996) Preoperative biliary drainage, colonisation of bile and postoperative complications in patients with tumours of the pancreatic head: a retrospective analysis of 241 consecutive patients. Eur J Surg 162:881–888PubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2008

Authors and Affiliations

  • Alessandro Ferrero
    • 1
  • Roberto Lo Tesoriere
    • 1
  • Luca Viganò
    • 1
  • Luisa Caggiano
    • 1
  • Enrico Sgotto
    • 1
  • Lorenzo Capussotti
    • 1
  1. 1.Unit of Hepato-biliary-pancreatic and Digestive SurgeryOspedale Mauriziano “Umberto I”TorinoItaly

Personalised recommendations