ArticleSurgical endoscopy2025
Impact of preoperative biliary drainage on outcomes of pancreaticoduodenectomy in severe hyperbilirubinemia.
Article in Surgical endoscopy, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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Who cites it
3 citing papers in PubMed.
- Risk Factors for Peritonitis Associated With Endoscopic Ultrasound-guided Hepaticogastrostomy.DEN open · 2027Article
- Association of pre-drainage bilirubin levels and pathological features with survival in patients undergoing preoperative biliary drainage: a single-center retrospective study.Translational gastroenterology and hepatology · 2026Article
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6 authors.
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Abstract
backgroundOptimal management of patients with severe hyperbilirubinemia (> 14.6 mg/dL) undergoing pancreaticoduodenectomy remains controversial.
methodsSingle-center retrospective study of 665 pancreaticoduodenectomies (2007-2024). Patients were stratified: no preoperative biliary drainage (PBD) with high (> 14.6mg/dL, n = 83) or low (< 14.6mg/dL, n = 312) bilirubin; PBD for low bilirubin (n = 140); PBD for high bilirubin (n = 113). PRIMARY OUTCOMES: 90-day mortality, morbidity, and specific complications.
resultsNinety-day mortality was significantly higher in non-PBD patients with high bilirubin (13.3%) compared to other groups (2.9-5.7%, p = 0.001). Overall morbidity was also higher in this group (29.0% vs. 12.8-20.7%, p < 0.001). While PBD groups showed higher surgical site infections (21.2-26.4% vs. 9.6%, p = 0.001), non-PBD high-bilirubin patients demonstrated increased ARDS (6.0% vs. 0-1.4%, p = 0.016) and reoperation rates (18.1% vs. 9.3-11.5%, p = 0.029). Multivariate analysis identified preoperative bilirubin > 14.6mg/dL as an independent predictor of 90-day mortality.
conclusionPreoperative bilirubin ≥ 14.6mg/dL independently predicts perioperative morbidity and mortality following pancreaticoduodenectomy. These findings support preoperative biliary drainage in patients with severe hyperbilirubinemia to optimize surgical outcomes, despite PBD-associated infectious complications.
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