Impact of preparative preoperative biliary decompression and drainage in cases with benign obstructive jaundice (cholestasis due to calcular and post cholecystectomy common bile duct obstruction
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The purpose of this study is to evaluate the role and importance of biliary decompression and drainage as preparative preoperative symptomatic amelioration for benign cholestasis prior to surgical treatment and its effect on outcome in relation to patients without biliary drainage prior to any surgical intervention. The present study includes 200 patients with benign obstructive jaundice (118 cases with primary presentation & 82 patients with post cholecystectomy), presented to Benha University Hospitals during the period from Feb. 1999 to May 2001. Detailed medical, and surgical history, clinical examination, laboratory and radiological investigation were all considered accurately for all the patients. Preparative preoperative biliary drainage were performed in 145 patients (72.5%). Per cutaneous trans-hepatic biliary drainage (PTBD) performed in 58 patients (29%), and endoscopic biliary drainage in 87 patients (43.5%). Thirty four cases (17%), submitted to surgical intervention as the preoperative biliary decompression and drainage was failed. In conclusion, preparative preoperative biliary drainage in the included patients resulting in decrease morbidity, and mortality as it improves the nutritional deficits, infectious complications, hepatic functions and reserve, it also improves the impaired cardio-vascular and renal functions that have all been impacted on the outcome in comparison to patients without biliary drainage prior to surgical intervention.