Preoperative biliary drainage versus upfront surgery in moderately jaundiced patients undergoing pancreaticoduodenectomy: A single-institution comparative study
Year: 2026
Type: article
Study design: Observational Study
Abstract: Backgrounds/Aims: The effect of preoperative biliary drainage (PBD) on outcomes for pancreaticoduodenectomy (PD) patients with moderate jaundice (10-15 mg/dL) remains understudied. While PBD aims to improve hepatic function, it may increase morbidity due to infections. Methods: This study analyzed PDs performed between July 2022 and 2025. Patients with periampullary cancers and bilirubin levels of 10-15 mg/dL were included. We compared patients who underwent upfront PD (upfront surgery [UP] group) with those who received PBD (via endoscopic retrograde cholangiopancreatography or percutaneous transhepatic biliary drainage) regarding perioperative outcomes, morbidity, mortality, bile microbiology, antibiotic use, and costs. Results: = 0.001). Overall morbidity, Clavien-Dindo grade 3 complications, and 90-day mortality rates were similar between the groups. However, antibiotic costs were significantly higher in the PBD group (₹31,047 vs. ₹20,937; + 50%). Conclusions: In patients with moderate jaundice (10-15 mg/dL), upfront PD can be performed safely. Routine PBD offers no clinical benefit and is associated with higher rates of SSIs, bile contamination, and increased costs.
Authors: Kaushal Singh Rathore, Gaurav Kaushal
Institution: All India Institute of Medical Sciences
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7146999900
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