Outcome of Removal of Biliary Stent Prior to Pancreaticoduodenectomy
Abstract
Background: Obstructive jaundice is the commonest manifestation in patients with periampullary carcinoma. Pancreaticodudenctomy is the only curative procedure for resectable tumor. But raised serum bilirubin level may cause the postoperative events. For that reason, preoperative biliary drainage is an important step to reduce the overall postoperative complications. The main aim of this study is to assess the rate of post-operative complications, length of hospital stays and death between patients undergoing pancreaticoduduenectomy with or without removal of biliary stent. Methodology: This prospective cross-sectional study was conducted into department of Surgery and Hepatobiliary, pancreatic and liver transplantation Surgery of BSMMU from July,2017 to June 2018. Initially all the patient diagnosed as periampullary carcinoma and underwent preoperative biliary drainage were enrolled in the study by purposive sampling. Surgery was planned 4-6 weeks after stenting. The analysis was done by student’s t test here. Cross tabulation and chi square test were done to analyze the categorical data. p value was considered as significant at <0.05. Data analysis was done using the software statistical package for social science (SPSS-23. Results: Patients with biliary stent in situ till pancreaticoduodenectomy was significantly associated with positive bile culture (P=0.025) and, E. coli (45.45%) is the most common organism. Post-operative woundinfection was significantly high (p=0.035) in Group A than Group B. From the point of view of postoperative morbidity Group B showed better results than Group A. Microscopic findings of bile duct showed disruption of mucosal epithelium in all 11 (100%) patients in Group A in contrast it was in 3 (33.33%) patients in Group B, which was statistically significant (P value <0.05). Conclusion: Removal of biliary stent before surgery who already underwent preoperative biliary decompression for improvement of liver function showed relatively better outcome after surgery in comparison to those patients in whom pancreaticoduodenectomy was done with keeping stent in situ.
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References
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