Impact of intraoperative retrograde transhepatic biliary drainage on clinically relevant postoperative pancreatic fistula following pancreaticoduodenectomy: a retrospective cohort study
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background: Postoperative pancreatic fistula (POPF) remains a major complication after pancreaticoduodenectomy (PD). Retrograde transhepatic biliary drainage (RTBD) may provide external biliary decompression and reduce mechanical stress around the pancreaticojejunostomy, but its effect on clinically relevant POPF (CR-POPF) remains uncertain. To evaluate the association between perioperative external biliary decompression, primarily using RTBD, and CR-POPF after PD.Methods: We retrospectively analyzed 235 consecutive patients who underwent PD between October 2008 and December 2025. The drainage group included 90 patients with intraoperative RTBD and 41 with preoperative percutaneous transhepatic biliary drainage (PTBD) maintained perioperatively; 104 patients had no external biliary drainage. CR-POPF was defined according to the 2016 International Study Group of Pancreatic Surgery (ISGPS) criteria. Full-cohort multivariable analysis was primary, with propensity score matching (PSM) as a sensitivity analysis.Results: CR-POPF occurred in 13 patients (9.9%) in the drainage group and 14 (13.5%) in the control group. External biliary decompression was not independently associated with CR-POPF [adjusted odds ratio (OR) =0.56; 95% confidence interval (CI): 0.23–1.35]. Soft pancreatic texture was independently associated with CR-POPF (adjusted OR =5.30; 95% CI: 1.15–24.50; P=0.03). After PSM, 93 patients remained in each group, with similar CR-POPF rates (10.8% vs. 12.9%).Conclusions: Perioperative external biliary decompression, primarily using RTBD, is not associated with a lower incidence of CR-POPF after PD.
Source: Gland Surgery
Authors: Kilhwan Kim, Sanghyun Song, Sungho Jo
Institution: Dankook University Hospital
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7221779064