Biliary Drainage Before Pancreaticoduodenectomy: A Comparison of Outcomes between Plastic and Metallic Biliary Stent: Eight-Year Experience from an Oncology Center

Research Article

Abstract

Objective: Preoperative biliary drainage (PBD) prior to pancreaticoduodenectomy (PD) has limited, but definite indications. Patients are often referred to high volume centers after PBD. This study seeks to compare the magnitude of complications between different PBD modalities (Plastic and SEMS) in patients undergoing PD at our oncology center.

Material and Methods: The Electronic Medical Records of the patients who had undergone PD between August 2011 and May 2019 were retrospectively analyzed. Chi-square and Mann-Whitney U test were used to test for statistically significant difference between categorical and nonparametric continuous variables respectively.

Results: Between August 2011 to May 2019, 167 patients with mean age of 57 years (117 males) underwent PD. PBD was performed in 64% patients with majority (83, 78%) done outside. The plastic stent (PS=74, 89%) was commonest in this group and three (4%) had self-expanding metal stents (SEMS). In our hospital, three fourth PBD was done with SEMS. There was no statistically significant difference of median pre-stenting serum bilirubin (p=0.5) between us and other centers. In pre-operative waiting period 25% patients experienced stent related complications,19 (24.6%) in the PS group and three (14.8%) in SEMS (p=0.29), commonest being cholangitis (n=23,85%). The median interval between PBD and complications was 29 days (range 0-101). Apart from post operative surgical site infection PS and SEMS group did not differ in peri and post operative outcomes.

Conclusion: Plastic stent continues to be the popular modality of PBD in low-income countries. If surgery is not delayed after PBD in our experience PS seemed to perform equally effectively.