4652 The effectiveness of preoperative drainage for malignant biliary obstruction.

Background :Malignant biliary obstruction carries a very poor prognosis. Preoperative biliary drainage provides a better surgical condition, but some reports show various adverse effects of this procedure.We evaluated the effectiveness of preoperative drainage with the assessment of several factors which might influence clinical outcome. Methods :Forty-four patients with malignant biliary obstruction who underwent Whipple's operation from January, 1996 to March, 1999 were analyzed. The patients were divided into 3 groups: no drainage, PTBD and ENBD groups.We analyzed patient chracteristics, laboratory findings, operating factors, hospital courses and complications. Statistical evaluation was performed using Kruskal-Wallis one-way ANOVA test and Mann-Whitney U-Wilcoxon Rank Sum W test by SPSS programe. Results :There were no differences of basic characteristics, initial or preoperative laboratory data, tumor size and invasiveness. Significant difference couldn't be found between complications, operating factors and hospital courses, however, the duration of jaundice in PTBD group were longer than in ENBD group. The drain itself was well functioning because there was no difference of preoperative bilirubin. To divide the patients according to initial bilirubin >or ≤9.0 mg/dl, there was also no difference of hospital courses and operating factors except day of jaundice, initial bilirubin and alkaine phosphatase expressed a biliary obstructive data. Conclusion :The preoperative biliary drainage in malignant biliary obstruction did not affect postoperative complications, operative difficulty and hospital courses. Careful patient selection could be recommended.