Management of preoperative biliary drainage on postoperative complications and mortality in patients with different degrees of obstructive jaundice undergoing pancreaticoduodenectomy.

Backgrounds/aims: The role of preoperative biliary drainage (PBD) in improving perioperative outcomes for patients with obstructive jaundice remains controversial. This retrospective study aims to evaluate the impact of PBD in patients with varying severities of jaundice and to identify optimal strategies to minimize complications and mortality following pancreaticoduodenectomy (PD).

Methods: This retrospective clinical study included 240 patients with obstructive jaundice who underwent PD. Patients were categorized into severe Jaundice group (SJ group) and moderate Jaundice group (MJ group). Preoperative, intraoperative, and postoperative clinical data were compared based on whether PBD was performed. Additionally, the association between PBD duration and postoperative complications and mortality after PD was assessed.

Results: Among 115 patients in the SJ group, 94 received PBD, whereas 46 of the 125 patients in the MJ group received PBD. In the SJ-PBD group, the rate of postoperative bile leakage was significantly lower compared with the direct surgery group; however, overall complication rates did not differ. In the MJ-PBD group, the incidence of incision-related complications increased significantly, with no notable reduction in overall postoperative complications. Patients who underwent PBD for at least 10 days experienced lower rates of severe complications (Clavien-Dindo grade ≥ 3) than patients with PBD duration less than 10 days (14.3% vs. 25.5%, p = 0.012).

Conclusions: PBD should be considered in obstructive jaundiced patients with total bilirubin > 256 μmol/L, particularly those presenting with systemic functional impairment. A minimum PBD duration of 10 days appears beneficial for reducing the risk of serious postoperative complications and mortality.