Merits, demerits and methods of preoperative biliary drainage for malignant obstructive jaundice

One hundred twenty-four patients with malignant obstructive jaundice undergoing Whipple's procedure were divided into two groups. Group I, 72 patients with an average preoperative serum bilirubin level of 13.3 mg/dl underwent pancreaticoduodenectomy after the level dropped to 5.88 mg/dl by preoperative external biliary drainage (21 patients with PTCD and 51 with cholecystostomy). Group II, 52 patients with a mean bilirubin level of 7.18 mg/dl received Whipple' procedure without preoperative drainage. There was no significant difference in mortality and morbidity between the two groups. We believed that biliary drainage is essential to patients with severe jaundice, otherwise the mortality and morbidity would be much higher AS to method of biliary drainage, we recommend cholecystostomy in hands not skillful with PTCD.