Effect of preoperative biliary drainage on complications and short-term mortality after pancreaticoduodenectomy: a Meta-analysis

Objective To investigate the effect of preoperative biliary drainage ( PBD) on complications and short-term mortality after pancreaticoduodenectomy ( PD) . Methods Related databases such as Pub Med, Embase, and the Cochrane Library, as well as main gastroenterological journals in the US, were searched for the articles on the effect of PBD on PD published from January 1, 2010 to January 1, 2017. Reviews Manager 5. 3 software was used for the statistical analysis of the incidence rates of total complications, infection, and anastomotic fistula and short-term mortality rate after surgery. Results Eight articles involving 2687 patients were included in the meta-analysis. These patients were divided into PBD group and non-PBD group according to whether they underwent PBD before PD. There was no significant difference in short-term mortality rate between the PBD group and the non-PBD group ( odds ratio [OR]= 1. 19, 95% confidence interval [CI]: 0. 79-1. 80, P = 0. 41) . Compared with non-PBD group, the PBD group had significantly higher incidence rates of total postoperative complications ( OR = 1. 95, 95% CI: 1. 24-3. 06, P = 0. 004) and postoperative infection ( OR = 2. 37, 95% CI: 1. 45-3. 87, P = 0. 000 5) . There was no significant difference in the incidence rate of postoperative anastomotic leak between the two groups ( OR =1. 43, 95% CI: 0. 95-2. 14, P = 0. 09) . Conclusion PBD does not bring benefits to patients'prognosis after surgery and it may increase the incidence rates of total postoperative complications and postoperative infection. Therefore, PBD is not recommended as conventional preoperative treatment for PD.