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Evidence summaries

Preoperative Biliary Drainage for Obstructive Jaundice

Pre-operative biliary drainage may not have beneficial effect on mortality and complications in patients with obstructive jaundice needing surgery. In some specific lesion site it may cause more complications. Level of evidence: "C"

A Cochrane review [Abstract] 1 included 6 studies with a total of 520 subjects. Four trials compared percutaneous transhepatic biliary drainage with direct surgery, and 2 trials used endoscopic sphincterotomy and stenting as the method of drainage. The proportion of patients with malignant obstruction varied between 60% and 100%. There was no significant difference in mortality between the pre-operative biliary drainage group and the direct surgery group (Table 1).

OutcomesNo of Participants (studies)Assumed risk (control)Corresponding riskRelative effect (95% CI)
Mortality520 (6)133 per 1000149 per 1000 (97 to 228)RR 1.12 (0.73 to 1.71)
Morbidity503 (6)361 per 1000599 per 1000 (462 to 780)Rate ratio 1.66 (1.28 to 2.16)

The overall serious morbidity was higher in the pre-operative biliary drainage group. There was no significant difference in the length of hospital stay (2 trials, 271 patients; MD 4.87 days; 95% CI -1.28 to 11.02; P = 0.12) between the two groups.

Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment and lack of blinding) and by imprecise results (few patients and wide confidence intervals).

References

  • Wang Q, Gurusamy KS, Lin H, Xie X, Wang C. Preoperative biliary drainage for obstructive jaundice. Cochrane Database Syst Rev. 2012;(3):CD005444.

Primary/Secondary Keywords