ArticleAnnals of hepato-biliary-pancreatic surgery2026
Preoperative biliary drainage versus upfront surgery in moderately jaundiced patients undergoing pancreaticoduodenectomy: A single-institution comparative study.
Article in Annals of hepato-biliary-pancreatic surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Backgrounds/Aims: The effect of preoperative biliary drainage (PBD) on outcomes for pancreaticoduodenectomy (PD) patients with moderate jaundice (10-15 mg/dL) remains understudied. While PBD aims to improve hepatic function, it may increase morbidity due to infections. Methods: This study analyzed PDs performed between July 2022 and 2025. Patients with periampullary cancers and bilirubin levels of 10-15 mg/dL were included. We compared patients who underwent upfront PD (upfront surgery [UP] group) with those who received PBD (via endoscopic retrograde cholangiopancreatography or percutaneous transhepatic biliary drainage) regarding perioperative outcomes, morbidity, mortality, bile microbiology, antibiotic use, and costs. Results: Among 92 PD patients, 40 met the inclusion criteria (UP = 16; PBD = 24). Baseline characteristics were comparable, except for higher bilirubin levels in the UP group (12.6 mg/dL vs. 1.35 mg/dL, Conclusions: In patients with moderate jaundice (10-15 mg/dL), upfront PD can be performed safely. Routine PBD offers no clinical benefit and is associated with higher rates of SSIs, bile contamination, and increased costs.
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