Preoperative biliary drainage associated with biliary stricture after pancreaticoduodenectomy: a population-based study.

BACKGROUND: The rate of preoperative biliary drainage for pancreaticoduodenectomy has been increasing despite most recent evidence that favors avoiding it. Only a few studies have focused on late surgical complications - biliary stricture after pancreaticoduodenectomy and have produced only inconclusive results. We evaluate the role of preoperative biliary drainage in the formation of biliary stricture after pancreaticoduodenectomy.

METHODS: The Taiwan National Health Insurance Program is a mandatory health care plan that covers nearly the entire population of 23 million in this country. A retrospective study was conducted to analyze the database compiled by the Taiwan National Health Insurance between January 2000 and December 2011. We included only patients with at least 2 years of follow-up. A cohort of 2,087 patients with preoperative diagnosis of biliary obstruction that underwent pancreaticoduodenectomy was evaluated.

RESULTS: A total of 212 (10.1%) of the 2,087 studied patients needed intervention for biliary stricture after pancreaticoduodenectomy. The median time to biliary stricture formation was 15.2 months (range: 1.2-89.7 months). The cumulative biliary stricture rate was 6.9% (1 year), 15.8% (5 years), and 18.5% (10 year). Multivariate analysis showed preoperative biliary drainage (hazard ratio 1.78, 95% CI 1.27-2.50, P = 0.001) associated with biliary stricture after pancreaticoduodenectomy.

CONCLUSIONS: Preoperative biliary drainage increases biliary stricture rate after pancreaticoduodenectomy.