The role of preoperative biliary decompression in obstructive jaundice.

This article will examine the current role of preoperative biliary drainage by reviewing risk factors in the jaundiced patient, the results of retrospective and prospective studies of preoperative biliary decompression, and present indications for preoperative biliary drainage. We reviewed 26 articles published between 1934 and 1994. Information on the following topics is presented: Morbidity and Mortality, Risk Factors, Retrospective Studies, Prospective Randomized Studies, Internal Biliary Drainage, Preoperative Biliary Drainage in the Malnourished Patient, Preoperative Biliary Drainage for Cholangitis, Preoperative Biliary Drainage as a Technical Aid, and Preoperative Biliary Drainage Before Liver Resection. While the routine use of preoperative biliary drainage can not be recommended, it may be indicated in certain clinical situations. In a selected subset of patients who are severely malnourished or are suffering from acute suppurative cholangitis preoperative drainage may be beneficial. Finally, preoperative placement of biliary catheters may be a useful technical aid in patients requiring a difficult hilar dissection for proximal biliary diseases.