The Role of Preoperative Biliary Decompression in Patients with Severe Malignant Obstructive Jaundice

  • Vincenzo Cangemi
  • Enrico Fiori
Part of the Updates in Surgery book series (UPDATESSURG)


The advantage of preoperative biliary drainage (PBD) in severe and persistent obstructive jaundice, ensuing tumors of the head of the pancreas, of the Papilla of Vater or of the common bile duct, has been widely debated without achieving tangible or definitive results.


Biliary Drainage Obstructive Jaundice Preoperative Biliary Drainage Biliary Decompression Endoscopic Biliary Drainage 


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  1. 1.
    Lillemoe KD (1999) Preoperative biliary drainage and surgical outcome. Ann Surg 230:143–144PubMedCrossRefGoogle Scholar
  2. 2.
    Gouma DJ, Moody G (1984) Preoperative percutaneous drainage: use or abuse. Surg Gastroenterol 3:74–80PubMedGoogle Scholar
  3. 3.
    Smith RC, Pooley M, George CRP et al (1985) Preoperative percutaneous transhepatic internal drainage in obstructive jaundice: a randomized controlled trial examining renal function. Surgery 97:641–647PubMedGoogle Scholar
  4. 4.
    Naakeb A, Pitt HA (1995) The role of preoperative biliary decompression in obstructive jaundice. Hepatogastroenterology 42:332–337Google Scholar
  5. 5.
    Denning DA, Ellison EC, Carey LC (1981) Preoperative percutaneous transhepatic biliary decompression operative morbidity in patients with obstructive jaundice. Am J Surg 141:61–65PubMedCrossRefGoogle Scholar
  6. 6.
    Lygidakis NJ, Van der Heyde MN, Lubbers MJ (1987) Evaluation of preoperative biliary drainage in the surgical management of pancreatic head carcinoma. Acta Chir Scand 153:665–668PubMedGoogle Scholar
  7. 7.
    Gundry SR, Strodel WE, Knol JA et al (1984) Efficacy of preoperative biliary tract decompression in patients with ostructive jaundice. Arch Surg 119:703–708PubMedGoogle Scholar
  8. 8.
    Wig JD, Kumar H, Suri S et al (1999) Usefulness of percutaneous transhepatic biliary drainage in patients with surgical jaundice — a prospective randomised study. J Assoc Physicians India 47:271–274PubMedGoogle Scholar
  9. 9.
    Marcus SG, Dobriansky M, Shamamian P et al (1998) Endoscopic biliary drainage before pancreaticoduodenectomy for periampullary malignancies. J Clin Gastroenterol 26:125–129PubMedCrossRefGoogle Scholar
  10. 10.
    Sohn TA, Yeo CJ, Cameron JL et al (2000) Do preoperative biliary stents increase postpacreaticoduodenectomy complications? J Gastrointest Surg 4:258–267PubMedCrossRefGoogle Scholar
  11. 11.
    Sewnath ME, Birjmohun RS, Rauws EA et al (2001) The effect of preoperative biliary drainage on postoperative complications after pancreaticoduodenectomy. Am Coll Surg 192:726–734CrossRefGoogle Scholar
  12. 12.
    Srivastava S, Sikora SS, Kumar A et al (2001) Outcome following pancreaticoduodenectomy in patients undergoing preoperative biliary drainage. Dig Surg 18:381–387PubMedCrossRefGoogle Scholar
  13. 13.
    Sewnath ME, Karsten TM, Prins MH et al (2002) A meta-analysis on the efficacy of preoperative biliary drainage for tumors causing obstructive jaundice. Ann Surg 236:17–27PubMedCrossRefGoogle Scholar
  14. 14.
    Lai EC, Chu KM, Lo CY et al (1992) Surgery for malignant obstructive jaundice: analysis of mortality. Surgery 112:891–896PubMedGoogle Scholar
  15. 15.
    Karsten TM, Allema JH, Reinders M et al (1996) Preoperative biliary drainage, colonisation of bile and postoperative complications in patients with tumours of the pancreatic head: a retrospective analysis of 241 consecutive patients. Eur J Surg 162:881–888PubMedGoogle Scholar
  16. 16.
    Heslin MJ, Brooks AD, Hochwald SN et al (1998) A preoperative biliary stent in associated with increased complications after pancreatoduodenectomy. Arch Surg 133:149–154PubMedCrossRefGoogle Scholar
  17. 17.
    Povoski SP, Karpeh MS Jr, Conlon KC et al (1999) Association of preoperative biliary drainage with postoperative outcome following pancreaticoduodenectomy. Ann Surg 230:131–142PubMedCrossRefGoogle Scholar
  18. 18.
    Martignoni ME, Wagner M, Krähenbühl L et al (2001) Effect of preoperative biliary drainage on surgical outcome after pancreatoduodenectomy. Am J Surg 181:52–59PubMedCrossRefGoogle Scholar
  19. 19.
    Pisters PWT, Hudec WA, Hess KR et al (2001) Effect of preoperative biliary decompression on pancreaticoduodenectomy-associated morbidity in 300 consecutive patients. Ann Surg 234:47–55PubMedCrossRefGoogle Scholar
  20. 20.
    Kahl S, Zimmermann S, Pross M et al (2003) Endoscopic biliary in patients with pancreatic cancer. Zentralbl Chir 128:406–410PubMedCrossRefGoogle Scholar
  21. 21.
    Watanapa P (1996) Recovery patterns of liver function after complete and partial surgical biliary decompression. Am J Surg 171:230–235PubMedCrossRefGoogle Scholar
  22. 22.
    Hatfield ARW, Tobias R, Terblanche J et al (1982) Preoperative external biliary drainage in obstructive jaundice:a prospective controlled clinical trial. Lancet 2:896–899PubMedCrossRefGoogle Scholar
  23. 23.
    Mc Pherson GAD, Benjamin IS, Hodgson HJF et al (1984) Preoperative percutaneous transhepatic biliary drainage: the results of a controlled trial. Br J Surg 71:371–375CrossRefGoogle Scholar
  24. 24.
    Pitt HA, Gomes AS, Lois JF et al (1985) Does percutaneous biliary drainage reduce operative risk or increase hospital cost? Ann Surg 201:545–553PubMedCrossRefGoogle Scholar
  25. 25.
    Rougheen PT, Gouma DJ, Kulkarni AD et al (1986) Impaired specific cell-mediated immunity in experimental biliary obstruction and its reversibility by internal biliary drainage. J Surg Res 41:113–125CrossRefGoogle Scholar
  26. 26.
    Gouma DJ, Coelho JCU, Fisher JD et al (1986) Endotoxemia after of biliary obstruction by internal and external drainage in rats. Am J Surg 151:476–479PubMedCrossRefGoogle Scholar
  27. 27.
    Gouma DJ, Julio CU, Coelho PD et al (1986) The effect of preoperative internal and external biliary drainage on mortality of jaundiced rats. Arch Surg 122:731–4Google Scholar
  28. 28.
    Parks RW, Halliday MI, McCrory DC et al. (2003) Host immune responses and intestinal permeability in patients with jaundice. Br J Surg 90:239–245PubMedCrossRefGoogle Scholar
  29. 29.
    Thompson RL, Hoper M, Diamond T et al (1990) Development and reversibility of T lymphocyte dysfunction in experimental obstructive jaundice. Br J Surg 77:1229–1232PubMedCrossRefGoogle Scholar
  30. 30.
    Shibatani N, Yamamoto S, Kubota Y et al (2002) Neutrophil chemotaxis in bile ductobstructed rats, and effect of internal biliary drainage. Hepatogastroenterology 49:918–923PubMedGoogle Scholar
  31. 31.
    Bailey ME (1986) Endotoxin bile salys and renal function in obstructive jaundice. Br J Surg 63:774–778CrossRefGoogle Scholar
  32. 32.
    Schaffner F, Bacchin P, Hutterer F et al (1986) Mechanism of cholestasis: structural and biochemical changes in the liver and serum in rats after bile duct ligation. Gastroenterology 60:888–897Google Scholar
  33. 33.
    Ido M, Higashiguchi T, Tanigawa K et al (1995) Cell biological evaluation of biliary drainage prior to hepatectomy in obstructive jaundice. Hepatogastroenterology 42:308–316PubMedGoogle Scholar
  34. 34.
    Regan MC, Keane RM, Little D et al (1994) Postoperative immunological function and jaundice. Br J Surg 81:271–273PubMedCrossRefGoogle Scholar
  35. 35.
    Megison SM, Dunn CW, Horton JW et al (1991) Effects of relief of biliary obstruction on mononuclear phagocyte system function and cell mediated immunity. Br J Surg 78:568–571PubMedCrossRefGoogle Scholar
  36. 36.
    Ozawa K, Takasan H, Kitamura D et al (1973) Alteration of liver mitochondrial in a patients with biliary obstruction due to liver carcinoma. Am J Surg 126:653–657PubMedCrossRefGoogle Scholar
  37. 37.
    Cainzos M, Potel J, Puente JL (1988). Anergy in jaundiced patients. Br J Surg 75:147–149PubMedCrossRefGoogle Scholar
  38. 38.
    Koyama K, Takagi Y, Ito K et al (1981) Experimental and clinical studies on the effect of biliary drainage in obstructive jaundice. Am J Surg 142:293–299PubMedCrossRefGoogle Scholar
  39. 39.
    Faouzi S, Burckhardt BE, Hanson JC et al (2001) Anti-Fas induces hepatic chemokines and promotes inflammation by an NF-kB-independent, caspase-3-dependent Pathway. J Biol Chem 276:49077–49082PubMedCrossRefGoogle Scholar
  40. 40.
    Guicciardi ME, Deussing J, Miyoshi H et al (2000) Cathepsin B contributes to TNF-a-mediated hepatocyte apoptosis by promoting mitochondrial release of cytochrome c. J Clin Invest 106: 1127–137PubMedCrossRefGoogle Scholar
  41. 41.
    Murphy FR, Issa R, Zhou X et al (2002) Inibition of apoptosis of activated hepatic stellate cells by tissue inhibitor of metalloproteinase-1 is mediated via effects on matrix metalloproteinase inhibition. J Biol Chem 277:11069–11076PubMedCrossRefGoogle Scholar
  42. 42.
    Canbay A, Guicciardi ME, Higuchi H et al (2003) Cathepsin B inactivation attenuates hepatic injury and fibrosis during cholestasis. J Clin Invest 112:152–159PubMedGoogle Scholar
  43. 43.
    Faubion WA, Guicciardi ME, Miyoshi H et al (1999) Toxic bile salts induce rodent hepatocyte apoptosis via direct activation of Fas. J Clin Invest 103:137–145PubMedCrossRefGoogle Scholar
  44. 44.
    Slocum MM, Sittig KM, Specian RD et al (1992) Absence of intestinal bile promotes bacterial translocation. Am Surg 58:305–310PubMedGoogle Scholar
  45. 45.
    Diamond T, Dolan S, Thompson RLE et al (1990) Development and reversal of endotoxemia and endotoxin-related death in obstructive jaundice. Surgery 108:370–375PubMedGoogle Scholar
  46. 46.
    Clements WDB, Parks R, Erwin P et al (1996) Role of the gut in the pathophysiology of extrahepatic biliary obstruction. Gut 39:587–593PubMedCrossRefGoogle Scholar
  47. 47.
    Ding JW, Andersson R, Soltesz V et al (1993) The role of bile and bile acids in bacterial translocation in obstructive jaundice in rats. Eur Surg Res 25:11–19PubMedCrossRefGoogle Scholar
  48. 48.
    Ballinger AB, Wolley JA, Ahmed M et al (1998) Persistent systemic inflammatory response after stent insertion in patients with malignant bile duct obstruction. Gut 42:555–559PubMedCrossRefGoogle Scholar
  49. 49.
    Glauser MP, Zanetti G, Baumgartner JD et al (1992) Lo shock settico: patogenesi. Lancet 9:258–266Google Scholar
  50. 50.
    Padillo FJ, Muntane J, Montero JL et al (2002) Effect of internal biliary drainage on plasma levels of endotoxin, cytokines, and c-reactive protein in patients with obstructive jaundice. World J Surg 26:1328–1332PubMedCrossRefGoogle Scholar
  51. 51.
    Giacometti A, Cirioni O, Ghiselli R et al (2003) Administration of protegrin peptide IB-367 to prevent endotoxin induced mortality in bile duct ligated rats. Gut 52:874–878PubMedCrossRefGoogle Scholar
  52. 52.
    Fahey TJ, Yoshioka T, Shires T et al (1996) The role of tumour necrosis factor and nitric oxide in the acute cardiovascular response to endotoxin. Ann Surg 223:63–69PubMedCrossRefGoogle Scholar
  53. 53.
    Kimmings AN, van Deventer SJH, Obertop H et al (2000) Endotoxin, cytokines, and endotoxin binding proteins in obstructive jaundice and after preoperative biliary drainage. Gut 46:725–731PubMedCrossRefGoogle Scholar
  54. 54.
    Ding JW, Andersson R, Soltesz V et al (1993) The effect of biliary decompression on bacterial translocation in jaundiced rats. HPB Surg 7:99–110PubMedCrossRefGoogle Scholar
  55. 55.
    Ding JW, Andersson R, Stenram U et al (1992). Effect of biliary decompression on reticuloendothelial function in jaundiced rats. Br J Surg 79:648–652PubMedCrossRefGoogle Scholar
  56. 56.
    Grewe JW, Maessen JG, Tiebosch T (1990) Prevention of postoperative complications in jaundice rats: internal biliary drainage versus oral lactulose. Ann Surg 212:221–227Google Scholar
  57. 57.
    Dixon JM, Armstrong CP, Davies GC (1984) Pre-operative biliary drainage. Br J Surg 71:1007PubMedCrossRefGoogle Scholar
  58. 58.
    Wilkinson SP, Moodie H, Stomatakis JG (1976) Endotoxaemia and renal failure in cirrhosis and obstructive jaundice. Br Med J 2:1415–1418PubMedCrossRefGoogle Scholar
  59. 59.
    Cahill CJ (1983) Prevention of postoperative renal failure in patients with obstructive jaundice. The role of bile salts. Br J Surg 70:590–595PubMedCrossRefGoogle Scholar
  60. 60.
    Cahill CJ, Pain JA, Bailey ME (1987) Bile salts, endotoxin and renal function in obstructive jaundice. Surg Gynecol Obstet 165:519–522PubMedGoogle Scholar
  61. 61.
    Aly EA, Johnson CD (2001) Preoperative biliary drainage before resection in obstructive jaundice. Dig Surg 18:84–89PubMedCrossRefGoogle Scholar
  62. 62.
    Povoski SP, Karpeh MS, Conlon KC et al (1999) Preoperative biliary drainage: impact on intraoperative bile culture and infectious morbidity and mortality after pancreaticoduodenectomy. J Gastrointest Surg 3:496–505PubMedCrossRefGoogle Scholar
  63. 63.
    Hochwald SN, Burke EC, Jarnagin WR et al (1999) Association of preoperative biliary stenting with increased postoperative infectious complications in proximal cholangiocarcinoma. Arch Surg 134:261–266PubMedCrossRefGoogle Scholar
  64. 64.
    Coppola R, Riccioni ME, Ciletti S et al (2001) Periampullary tumors. Analysis of 319 consecutive cases submitted to preoperative endoscopic biliary drainage. Surg Endosc 15:1135–9PubMedCrossRefGoogle Scholar
  65. 65.
    Fiori E, Atella F, Gazzanelli S et al (1994) The usefulness of biliary drainage for restoring liver function in obstructive jaundice. Panminerva Medica 36:171–178PubMedGoogle Scholar
  66. 66.
    Fiori E, Macchiarelli G, Schillaci A et al (2003) Hepatocyte ultrastructural aspects after preoperative biliary drainage in pancreatic cancer patients with cholestatic jaundice. Anticancer Res 23:4859–4863PubMedGoogle Scholar

Copyright information

© Springer-Verlag Italia 2009

Authors and Affiliations

  • Vincenzo Cangemi
    • 1
  • Enrico Fiori
    • 1
  1. 1.Department of Surgery “P. Valdoni”University of Rome “La Sapienza”RomeItaly

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