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Perioperative outcome of Whipple’s procedure with special attention to the impact of preoperative biliary drainage: a real-life scenario

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Abstract

The aim of the present study is to report the overall perioperative outcome of Whipple’s procedure (WP) with particular attention to the impact of preoperative biliary drainage (PBD) on postoperative clinical outcome. All the patients who underwent WP at our institution between August 2007 and December 2019 were retrospectively reviewed. Impact of PBD and the stent-surgery interval on the postoperative clinical outcome of WP were analyzed. Of the total 404 patients, 254 (63%) were male. The median age at operation was 50 years. The overall morbidity was 57.7%. The most common complication was surgical site infection (SSI) (28.7%). POPF developed in 57 (14.1%) patients. Delayed gastric emptying, intra-abdominal collection, and postpancreatectomy hemorrhage developed in 82 (20%), 23 (5.7%), and 18 (4.5%) patients, respectively. PBD was performed in 175 (43%) patients. The median stent-surgery interval was 59 days. Postoperative overall complications and SSI were significantly more common in PBD patients. No significant difference in postoperative major complications or mortality was observed between PBD and no-PBD patients. Stent-surgery interval more than 6 weeks was not associated with increased postoperative complications or hospital stay. Similarly, PBD solely based on serum bilirubin ≥ 15 mg/dl has no beneficial effect on surgical outcome. The operative mortality was 4.2% (n = 17). The median postoperative hospital stay was 13 (7–68) days. PBD is associated with increased incidence of postoperative overall complications and SSI, but does not affect major complications or mortality. PBD-surgery interval greater than 6 weeks does not have a negative impact on postoperative clinical outcomes.

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Authors and Affiliations

  1. Division of Surgical Gastroenterology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, 244 A. J. C. Bose Road, Kolkata, West Bengal, 700020, India

    Sukanta Ray, Somak Das, Tuhin Subhra Mandal, Koustav Jana, Roby Das, Dilip Kumar, Zuber Ansari & Sujan Khamrui

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Contributions

SR was involved in study design, statistical analysis, writing, and drafting of the manuscript. SD, TSM, ZA, DK, KJ, RD, and SK were involved in data collection, literature search, statistical analysis, and critically revised the manuscript. All authors had read and approved the final manuscript.

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Correspondence to Sukanta Ray.

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We declare that we have no conflict of interest.

Ethical approval

Ethical approval was obtained from the ethical committee of our institution.

Human and animal rights

All the involved human participants were suffering from periampullary or pancreatic head pathology. Whipple's procedure is the treatment of choice for this group of patients. They underwent surgery according to the protocol of our institution. Informed written consent was obtained from each patient prior to surgery.

Informed consent

Informed consent was waived by our ethical committee because of retrospective nature of the study. All the procedures performed were part of routine care.

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Ray, S., Das, S., Mandal, T.S. et al. Perioperative outcome of Whipple’s procedure with special attention to the impact of preoperative biliary drainage: a real-life scenario. Updates Surg 73, 1735–1745 (2021). https://doi.org/10.1007/s13304-021-01038-y

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