August 15, 2025Open Access

Impact of preoperative biliary drainage on outcomes of pancreaticoduodenectomy in severe hyperbilirubinemia

Key Points

Ninety-day mortality was significantly higher at 13.3% for non-PBD patients with high bilirubin compared to lower levels, indicating a critical risk factor.
Overall morbidity for the high bilirubin non-PBD group was 29.0%, contrasting with 12.8–20.7% in PBD groups, showcasing implications on patient management strategies.
This analysis involved 665 pancreaticoduodenectomies and emphasized the role of preoperative bilirubin levels in surgical outcomes after biliary drainage.
Findings suggest that preoperative biliary drainage is beneficial despite higher rates of surgical site infections.

Abstract

Abstract Background Optimal management of patients with severe hyperbilirubinemia (> 14.6 mg/dL) undergoing pancreaticoduodenectomy remains controversial. Methods Single-center retrospective study of 665 pancreaticoduodenectomies (2007–2024). Patients were stratified: no preoperative biliary drainage (PBD) with high (> 14.6mg/dL, n = 83) or low ( 14.6mg/dL as an independent predictor of 90-day mortality. Conclusion Preoperative bilirubin ≥ 14.6mg/dL independently predicts perioperative morbidity and mortality following pancreaticoduodenectomy. These findings support preoperative biliary drainage in patients with severe hyperbilirubinemia to optimize surgical outcomes, despite PBD-associated infectious complications.

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