Preoperative biliary drainage.

[cholangiocarcinoma]

The role of preoperative biliary drainage (PBD ) in patients with distal or proximal biliary obstruction secondary to resectable tumors has been a matter for debate . A review of the literature using Medline , Embase and Cochrane databases was undertaken for studies evaluating routes of drainage (endoscopic or percutaneous ) and stent types (plastic or metal ) in patients with resectable disease . Preoperative biliary drainage is indicated for relief of symptomatic jaundice , cholangitis , patients undergoing neoadjuvant therapy or those patients where surgery may be delayed . Endoscopic methods are preferred over percutaneous methods because of lower complication rates . In patients with proximal biliary obstruction , PBD should be guided by imaging studies to aid in selective biliary cannulation for unilateral drainage in order to reduce the risk of cholangitis in undrained liver segments .