Abstracts
1999 Digestive Disease Week

# 2135 DO PREOPERATIVE BILIARY STENTS INCREASE POST-PANCREATICODUODENECTOMY COMPLICATIONS?
T A Sohn, Charles J Yeo, J L Cameron, H A Pitt, K D Lillemoe, Johns Hopkins Med Inst, Baltimore, MD

Background: It has been suggested that the placement of endoscopic or percutaneous biliary stents prior to pancreaticoduodenectomy (PD) increases postoperative morbidity. Methods: A retrospective review of a prospectively collected PD database was performed. Patients undergoing preoperative biliary stenting were compared to those who were not stented. In addition, outcomes after endoscopic and percutaneous stenting were compared. Patients who had undergone operative biliary bypass prior to PD were excluded. Results: Between January 1994 and December 1997, 567 patients underwent PD without prior operative biliary bypass. Preoperative biliary stenting was performed in 408 patients (72%), while the remaining 159 patients (28%) did not undergo biliary stenting. For the stented group, 64% were stented via a percutaneous approach and 36% were stented endoscopically. The stented patients were older (mean 63.1 years vs. 61.4 years, p=0.05) and more likely to be white (92% vs. 82%, p=0.005). Those who were stented were more likely to have jaundice (67% vs. 38%, p<0.0001) and fever (5% vs. 1%, p=0.03) as presenting symptoms. There were no differences in multiple intraoperative parameters or in the type of PD performed when comparing the two groups. Stented patients had a perioperative mortality rate of 1.7% compared to 2.5% in those not stented (p=NS). The overall complication rates were 35% in those stented and 30% in those not stented (p=NS). Despite this, stented patients experienced a significantly increased incidence of pancreatic fistula (10% vs. 4%, p=0.02) and wound infection (10% vs. 4%, p=0.02). The incidences of other postoperative complications were similar between the stented and unstented groups. Eight patients (3%) in the percutaneously- stented group developed significant hemobilia after stent placement, while no endoscopically-stented patients developed hemobilia (p=0.03). There were no significant differences in other complications between the percutaneously and endoscopically-stented groups. Conclusions: Preoperative biliary stenting did not increase the overall complication rate or mortality rate in patients undergoing PD. Stenting does appear to increase the rate of pancreatic fistula formation, possibly as a result of pancreatic inflammation related to the stenting procedure. Stenting also increases the rate of wound infection, possibly secondary to bactibilia after instrumentation of the biliary tree. Biliary stenting is safe, but should be used selectively due to the above mentioned risks. The method of stenting should be based on local expertise.

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