Preoperative Biliary Drainage for Patients with Perihilar Bile Duct Malignancy

  • Yu Takahashi
  • Hiromichi Ito
  • Yosuke Inoue
  • Yoshihiro Mise
  • Yoshihiro Ono
  • Takafumi Sato
  • Akio SaiuraEmail author
Original Article



Although endoscopic biliary stenting (EBS) is known to increase preoperative biliary drainage (PBD)-related complications including postoperative surgical site infection (SSI), EBS is still commonly placed before referral to tertiary centers. Whether exchanging EBS with external drainage methods mitigate the risk of SSI is unknown. This study sought to identify EBS-associated risk of recurrent biliary obstruction and postoperative SSI, with particular attention whether it was replaced with external drainage methods before surgery.


From January 2005 to December 2014, 102 consecutive patients with perihilar biliary cancer who underwent PBD followed by hepatobiliary resection were analyzed.


Among the enrolled patients, 49 (48.0%) underwent total 76 re-interventions due to recurrent biliary obstruction with a median number of 1 (range, 1 to 6). Cholangitis occurred more frequently in patients with EBS (26.9%) than in other methods (P < 0.001). The incidence of postoperative SSI was marginally higher among the patients with EBS at the time of surgery than those with previously placed EBS replaced by the external drainage (72.2% vs 38.5%, P = 0.060). In the multivariate analysis, presence of EBS at the time of surgery remained as an only independent predictor of SSI (95% CI, 1.46–17.32; P = 0.011).


The use of EBS increased recurrent biliary obstruction and postoperative SSI particularly when it is present at a time of definitive operation. Our findings support using external drainage such as by endoscopic nasobiliary drainage because of the lower associated incidence of these complications.


Preoperative biliary drainage Endoscopic biliary stenting at the time of surgery 


Authors’ Contributions

YT—conception or design of the work and drafting the work.

HI—conception or design of the work and drafting and critical revision of the work.

YI—conception or design of the work and critical revision of the work.

YO—conception or design of the work and critical revision of the work.

TS—conception or design of the work and critical revision of the work.

AS—conception or design of the work and critical revision of the work.

All authors approved the version of the manuscript to be published and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy and integrity of any part of the work were appropriately investigated and resolved.

Compliance with Ethical Standards

The Institutional Review Board of the Cancer Institute Hospital approved this study protocol (Approval number 2016-1136).

Conflict of Interest

The authors declare that they have no conflict of interest. This paper has not been previously presented elsewhere.


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Copyright information

© The Society for Surgery of the Alimentary Tract 2019

Authors and Affiliations

  • Yu Takahashi
    • 1
  • Hiromichi Ito
    • 1
  • Yosuke Inoue
    • 1
  • Yoshihiro Mise
    • 1
  • Yoshihiro Ono
    • 1
  • Takafumi Sato
    • 1
  • Akio Saiura
    • 1
    Email author
  1. 1.Department of Gastroenterological Surgery, Cancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan

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