Abstract
Background Surgeons and endoscopists welcome routine preoperative biliary drainage prior to
pancreaticoduodenectomy despite evidence that it increases complications. Its effect
on postoperative pancreatic fistula is variably reported in literature. Simultaneous
biliary and pancreatic drainage is rarely performed for very selected indications
and its effects on postoperative pancreatic fistula are largely unknown. Our aim was
to analyze the same while eliminating confounding factors.
Methods Retrospective single center cohort study of patients who underwent pancreaticoduodenectomy
over the past 10 years for carcinoma obstructing the lower common bile duct. Patients
who underwent biliary stenting alone, biliary and pancreatic stenting, and no stenting
prior to pancreaticoduodenectomy were the three study cohort groups and their records
were scrutinized for the incidence of postoperative pancreatic fistula.
Results Sixty-two patients underwent biliary stenting alone, 5 patients underwent both biliary
and pancreatic stenting, and 237 patients were not stented in the adenocarcinoma group
without chronic pancreatitis. The pancreatic fistula rate was similar in the patients
who underwent biliary stenting alone when compared with the group which was not stented.
(24/62 versus 67/237, odds ratio [OR] =0.619, confidence interval (CI) =0.345–1.112,
p = 0.121). However, the patients who underwent both biliary and pancreatic stenting
had a significant increase in postoperative pancreatic fistula compared with the not
stented (p = 0.003). By univariate and multivariate analysis using Firth logistic regression,
pancreatic texture (OR = 1.205, CI = 0.103–2.476, p = 0.032) and the presence of a biliary and pancreatic stent (OR = 2.695, CI = 0.273–7.617,
p = 0.027) were the significant factors affecting pancreatic fistula.
Conclusion Preoperative biliary drainage alone has no significant influence on postoperative
pancreatic fistula except when combined with pancreatic stenting. We need more such
studies from other centers to confirm that the rare event of preoperative biliary
and pancreatic stenting has indeed this harmful effect on healing of postoperative
pancreatic anastomosis.
Keywords
preoperative biliary drainage - postoperative pancreatic fistula - pancreaticoduodenectomy