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Steven R. Gundry, MD; William E. Strodel, MD; James A. Knol, MD; Frederic E. Eckhauser, MD; Norman W. Thompson, MD

Arch Surg. 1984;119(6):703-708.

Abstract
• Fifty consecutive matched patients with benign or malignant biliary tract obstruction were compared to determine the efficacy of preoperative percutaneous biliary drainage (PBD). Twenty-five patients underwent PBD for an average of nine days before operation; 25 patients underwent percutaneous transhepatic cholangiography (PTHC) followed immediately by operation. Serum bilirubin levels before PTHC were 16.5±7.6 mg/dL and 14.9±7.6 mg/dL in PBD and non-PBD groups, respectively. Serum bilirubin levels decreased to 6.5±6.2 mg/dL preoperatively in patients having PBD. One week after operation, bilirubin levels were 4.2 ±4.3 mg/dL and 9.0±5.2 mg/dL in the PBD and non-PBD groups, respectively. Major morbidity (sepsis, abscess, renal failure, or bleeding) occurred in two patients (8%) having PBD and in 13 patients (52%) without PBD. One patient (4%) with PBD, and five patients (20%) without PBD, died. The mean hospital stay was shorter for the PBD group. Preoperative PBD reduces operative mortality and morbidity and results in a more rapid resolution of hyperbilirubinemia during the postoperative period.

(Arch Surg 1984;119:703-708)

Author Affiliations
From the Department of Surgery, Section of General Surgery, University of Michigan Medical Center, Ann Arbor.

Footnotes
Accepted for publication Jan 11, 1984.

Read before the 91st annual meeting of the Western Surgical Association, Monterey, Calif, Nov 16, 1983.

Reprint requests to D 2220 SACB, University Hospital, Ann Arbor, MI 48109 (Dr Strodel).

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