Meta-analysis of randomized clinical trials on safety and efficacy of biliary drainage before surgery for obstructive jaundice

Author:

Fang Y1,Gurusamy K S2,Wang Q3,Davidson B R2,Lin H4,Xie X1,Wang C1

Affiliation:

1. Department of Neurosurgery, China

2. Department of Surgery, UCL Medical School, Royal Free Campus London, UK

3. Department of Endocrinology, China

4. Books and Information Centre, West China Hospital, Sichuan University, Chengdu, China

Abstract

Abstract Background This meta-analysis aimed to investigate whether preoperative biliary drainage (PBD) is beneficial to patients with obstructive jaundice. Methods Data from randomized clinical trials related to safety and effectiveness of PBD versus no PBD were extracted by two independent reviewers. Risk ratios, rate ratios or mean differences were calculated with 95 per cent confidence intervals (c.i.), based on intention-to-treat analysis, whenever possible. Results Six trials (four using percutaneous transhepatic biliary drainage and two using endoscopic sphincterotomy) including 520 patients with malignant or benign obstructive jaundice comparing PBD (265 patients) with no PBD (255) were included in this review. All trials had a high risk of bias. There was no significant difference in mortality (risk ratio 1.12, 95 per cent c.i. 0·73 to 1·71; P = 0·60) between the two groups. Overall serious morbidity (grade III or IV, Clavien–Dindo classification) was higher in the PBD group (599 complications per 1000 patients) than in the direct surgery group (361 complications per 1000 patients) (rate ratio 1·66, 95 per cent c.i. 1·28 to 2·16; P < 0·001). Quality of life was not reported in any of the trials. There was no significant difference in length of hospital stay between the two groups: mean difference 4·87 (95 per cent c.i. −1·28 to 11·02) days (P = 0·12). Conclusion PBD in patients undergoing surgery for obstructive jaundice is associated with similar mortality but increased serious morbidity compared with no PBD. Therefore, PBD should not be used routinely.

Publisher

Oxford University Press (OUP)

Subject

Surgery

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