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    • Observation of clinical efficacy of PTCD to decrease bilirubin before laparoscopic pancreaticoduodenectomy (with video)

      Online: September 28,2022

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      Abstract:Background and Aims: A number of studies have proved that percutaneous transhepatic cholangial drainage (PTCD) for jaundice reduction can improve the immunity and digestive function of patients with jaundice after surgery, but the effect of using PTCD during open pancreaticoduodenectomy (OPD) on the incidence of postoperative complications is not significant. However, the application efficacy of PTCD in laparoscopic pancreaticoduodenectomy (LPD) still needs to be studied. Therefore, this study was performed to investigate the effectiveness and safety of preoperative PTCD in patients undergoing LPD. Methods: The clinical data of 42 patients undergoing LPD in Baoji People"s Hospital from January 2019 to December 2021 were retrospectively analyzed. Of the 42 patients, 25 patients underwent PTCD to decrease bilirubin before surgery (PTCD group), and the remaining 17 patients did not undergo preoperative PTCD (non-PTCD group). The baseline characteristics and perioperative variables of the two groups were compared. Results: The mean time of preoperative biliary drainage in PTCD group was (6.81±1.52) d. The intraoperative blood loss was significantly less (322.21 mL vs. 435.17 mL, P=0.000), and the incidence rates of bile leakage (0.00 vs. 23.53%, P=0.000) and the overall complications (16.00% vs. 47.06%, P=0.029) were significantly lower in PTCD group than those in non-PTCD group. There were no significant differences between PTCD group and non-PTCD group in terms of operative time for LPD (366.26 min vs. 381.21 min), time to first postoperative bowel movement (2.36 d vs. 2.51 d), time to drainage tube removal (4.46 d vs. 4.25 d), length of total hospital stay (15.27 d vs. 13.58 d), readmission rate within 30 d (16.00% vs. 17.65%) and incidence rates of other specific complications (all P>0.05). Conclusion: Routine performance of preoperative PTCD to decrease bilirubin in patients scheduled to undergo LPD can reduce the amount of intraoperative blood loss, reduce the incidence rates of overall complications and bile leakage, and it is recommended to be used in clinical practice. However, its indications and safety still need to be further investigated and verified by studies with large sample size.

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