A meta-analysis of the effect of preoperative biliary stenting on patients with obstructive jaundice

Abstract

The goal of this study was to systematically review the effects of biliary stenting on postoperative morbidity and mortality of patients with obstructive jaundice. PubMed, Embase, Cochrane Library, and other relevant databases were searched by computer and manually for published and unpublished studies on the impact of preoperative biliary drainage on patients with obstructive jaundice from 2000 to the present day. Two investigators independently selected the studies according to the inclusion and exclusion criteria, extracted the data, and assessed the quality of the selected studies. Meta-analysis was performed to compare postoperative morbidity and mortality of patients between the drainage and nondrainage groups.Compared with the nondrainage group, the overall mortality, overall morbidity, infectious morbidity, incidence of wound infection, intra-abdominal abscess, pancreatic fistulas, bile leak, and delayed gastric emptying in the drainage group were not significantly different. Compared with the nondrainage group, the drainage group had a drainage time of <4 weeks with an increased overall morbidity by 7% to 23%; however, the overall morbidity of the drainage group with a drainage time >4 weeks was not significantly different. Compared with the nondrainage group, the overall mortality of the drainage group using metal stents and plastic stents as internal drainage devices was reduced by 0.5% to 6%, whereas that of the drainage group using plastic stent devices was not significantly different.In summary, preoperative drainage should be applied selectively. The drainage time should be >4 weeks, and metal stents should be used for internal drainage.

FIGURE 1

(A) Overall mortality, (B) overall morbidity, (C) infectious morbidity, (D) wound infection, (E) intra-abdominal abscess, (F) pancreatic fistula, (G) bile leak, (H) delayed gastric emptying.

FIGURE 1 (Continued)

(A) Overall mortality, (B) overall morbidity, (C) infectious morbidity, (D) wound infection, (E) intra-abdominal abscess, (F) pancreatic fistula, (G) bile leak, (H) delayed gastric emptying.

FIGURE 2

(A) Overall mortality, (B) overall morbidity, (C) infectious morbidity, (D) wound infection, (E) intra-abdominal abscess, (F) pancreatic fistula, (G) bile leak, (H) delayed gastric emptying.

FIGURE 3

(A) Comparison of total morbidity between the nondrainage and drainage groups with drainage times <4 weeks. (B) Comparison of total morbidity between the nondrainage and drainage groups with drainage time >4 weeks.

FIGURE 4

(A) Comparison of total mortality between the nondrainage and drainage groups using plastic and metal as stent material. (B) Comparison of total mortality between the nondrainage and drainage groups using plastic as stent material.