Intraoperative continuous external bile drainage during pancreaticoduodenectomy.

PURPOSE: The common hepatic duct is usually divided during the early stage of pancreaticoduodenectomy. However, abrupt, complete, and prolonged closure of the proximal common duct stump can cause liver damage in the course of this long operation, resulting in postoperative liver dysfunction and associated complications. Here, we investigate this phenomenon further.

METHODS

We performed intraoperative continuous external bile drainage (IBD) in 43 consecutive patients (drainage group) and compared postoperative liver enzyme levels, morbidity including liver dysfunction, and outcomes with those of a control group (n = 41).

RESULTS

There were no complications associated with IBD catheter insertion in this series. The drainage group had significantly lower transaminase levels within the first 7 postoperative days (PODs) than the control group. Postoperative liver dysfunction was confirmed in six patients from the control group and in one patient from the drainage group (P = 0.04). However, there were no significant differences between these two groups in terms of postoperative morbidity (other than liver dysfunction), relaparotomy, and in-hospital mortality rates.

CONCLUSION

Intraoperative continuous external bile drainage failed to improve the overall morbidity and mortality rates in this series. However, our findings showed that prolonged intraoperative complete closure of the common hepatic duct contributed to postoperative liver dysfunction in most patients and that IBD, which is easy and safe to perform, could reduce intra-operative liver damage and prevent postoperative liver dysfunction.