Preoperative biliary drainage in obstructive jaundice

Background/Aims: Although the role of preoperative percutaneous transhepatic biliary drainage in obstructive jaundice has been the subject of controversy in many other countries, in Japan, almost all surgeons agree that biliary decompression should be performed prior to the surgical treatment in obstructive jaundice. This study was performed in order to determine the role of preoperative percutaneous transhepatic biliary drainage in obstructive jaundice. Patients and Methods: We evaluated 238 patients with preoperative obstructive jaundice, and also studied its pathophysiology in experimental animal models. Results: Both of these studies demonstrated that this procedure should be performed if the value of total bilirubin is more than 5 mg/dl, the ICG Rmax value of the future remnant liver is less than 0.4 mg/kg/min, and the duration of jaundice is more than 3 weeks. Preoperative biliary drainage improves the liver function, so that major operations can be safely performed without major complications. Conclusions: It therefore seems preferable that patients undergo preoperative biliary decompression to reduce serum total bilirubin to below 5 mg/dl, and to improve hepatic and reticuloendothelial functions and hepatic reserve prior to any major surgical operation.