Yangjun Li, Department of General Surgery, Ningbo No.2 Hospital, Ningbo, China
Tiequan Yang, Department of Intervention. Ningbo No.2 Hospital, Ningbo, China
Objective: The effect of a pre-operative biliary stent on complications after pancreaticoduodenectomy (PD) remains controversial. Materials and method: We conducted a meta-analysis according to the preferred reporting items for systematic reviews and meta-analyses guidelines, and PubMed, Web of Science Knowledge, and Ovid’s databases were searched by the end of February 2023. 35 retrospective studies and 2 randomized controlled trials with a total of 12641 patients were included. Results: The overall complication rate of the pre-operative biliary drainage (PBD) group was significantly higher than the no- PBD group (odds ratio [OR] 1.46, 95% confidence interval [CI] 1.22-1.74; p < 0.0001), the incidence of post-operative delayed gastric emptying was increased in patients with PBD compared those with early surgery (OR 1.21, 95% CI: 1.02-1.43; p = 0.03), and there was a significant increase in post-operative wound infections in patients receiving PBD with an OR of 2.2 (95% CI: 1.76-2.76; p < 0.00001). Conclusions: PBD has no beneficial effect on post-operative outcomes. The increase in postoperative overall complications and wound infections urges the exact indications for PBD and against routine pre-operative biliary decompression, especially for patients with total bilirubin < 250 umol/L waiting for PD.
Keywords: Pre-operative biliary drainage. Resectable. Periampullary lesions. Meta-analysis.