Endoscopic biliary drainage before pancreaticoduodenectomy for XXXX .

@entity1 @entity3883 @entity1087 @entity5 @entity648 @entity253
Despite decreased operative mortality, pancreaticoduodenectomy (PD) remains a formidable operation with substantial morbidity. We have evaluated the influence of preoperative @entity253 ( @entity253 ) on morbidity after PD for @entity5 by retrospectively reviewing the medical records of 182 @entity1 undergoing PD between April 1985 and August 1996. Of 52 study @entity1 with @entity3883 , 22 underwent preoperative @entity253 , and 30 were not drained. Eighty-three @entity1 were excluded for @entity648 levels less than 5 mg/dl, 43 had other biliary drainage, and 4 had @entity1087 with benign pathology. Preoperative, intraoperative, and postoperative factors were compared. The two groups were well matched for clinical presentation and operative characteristics except for lower preoperative values of liver chemistries in @entity1 undergoing @entity253 . Length of postoperative hospitalization for @entity1 undergoing @entity253 was 13.5 days, compared with 19 days for @entity1 who were not drained (p = 0.02). @entity1 who were not drained tended to have more overall complications (p = 0.054). Multivariate analysis revealed time to regular diet (p < 0.0001) and no preoperative drainage (p = 0.04) to be independent factors significantly increasing the length of hospitalization. Endoscopic biliary drainage before PD significantly reduced the length of postoperative hospitalization and was associated with less postoperative morbidity. Further studies, including cost analysis, are warranted.
