Preoperative biliary decompression in patients, suffering tumorogenic obturation jaundice, complicated by cholangitis, and its impact on development of postoperative complications

Abstract

Objective.To estimate the impact of preoperative biliary decompression inpatients, suffering tumorogenic obturation jaundice, complicated by ascending cholangitis, on development of postoperative complications. Materials and methods. The one-centre retrospective investigation of the treatment results was conducted in 136 patients, suffering tumorogenic obturation jaundice. In 84 patients preoperative biliary decompression was done (Group I). In 52 patients preoperative biliary decompression was not performed (Group II).In all the Group I patients an ascending preoperative cholangitis was diagnosed: in 48 (57.1%) -of the I degree severity, in 36 (42.9%) - of the II degree of severity. In 21 (40.4%) patients of Group II preoperative ascending cholangitis I degree of severity was revealed. Results. Performance of preoperative biliary decompression did not worsen postoperative results, taking into account the postoperative complications structure (p=0.07), but influenced the wound infection development (p=0.01). Additional factors were determined: preoperative ascending cholangitis of I degree (p=0.007) and II degree (p=0.001) of severity; hyperbilirubinemia over 250 mcmol/l (p= 0.03); delay in operative treatment more than by 3 weeks after preoperative biliary decompression (р= 0.02); presence of the antibioticoresistant microflora in a time of preoperative biliary decompression (p=0.009) and at the operation time (p=0.002). Conclusion. Performance of preoperative biliary decompression raises the risk for the wound infection development, but is not the cause for postoperative prognosis worsening, taking into account the postoperative complications structure.

Keywords

• obturation jaundice
• preoperative biliary decompression
• ascending cholangitis
• postoperative complications
• hyperbilirubinemia
• antibioticoresistence