BACKGROUND: Controversy exists regarding which approach is preferable among types of biliary drainage for obstructive jaundice before major hepatectomy: selective biliary drainage (SBD) only on the future remnant liver (FRL) or total biliary drainage (TBD). METHODS: There were 42 consecutive patients who underwent SBD (n = 15) or TBD (n = 27) for obstructive jaundice caused by a hepatobiliary malignancy, and subsequent portal vein embolization (PVE) before extended hemihepatectomy. The hypertrophy ratio, defined as the ratio of the FRL volume after PVE to that before PVE, was evaluated. The bilirubin clearance also was calculated. RESULTS: The hypertrophy ratio was higher in patients with SBD than in those with TBD (median, 128%; range, 111-152% vs median, 121%; range, 102-138%; P = .013). The bilirubin clearance of FRL with SBD was markedly improved after PVE compared with that in patients with TBD. CONCLUSIONS: SBD is superior to TBD in promoting hypertrophy of the FRL induced by PVE and in guaranteeing good liver function before major hepatectomy.
BACKGROUND: Controversy exists regarding which approach is preferable among types of biliary drainage for obstructive jaundice before major hepatectomy: selective biliary drainage (SBD) only on the future remnant liver (FRL) or total biliary drainage (TBD). METHODS: There were 42 consecutive patients who underwent SBD (n = 15) or TBD (n = 27) for obstructive jaundice caused by a hepatobiliary malignancy, and subsequent portal vein embolization (PVE) before extended hemihepatectomy. The hypertrophy ratio, defined as the ratio of the FRL volume after PVE to that before PVE, was evaluated. The bilirubin clearance also was calculated. RESULTS: The hypertrophy ratio was higher in patients with SBD than in those with TBD (median, 128%; range, 111-152% vs median, 121%; range, 102-138%; P = .013). The bilirubin clearance of FRL with SBD was markedly improved after PVE compared with that in patients with TBD. CONCLUSIONS: SBD is superior to TBD in promoting hypertrophy of the FRL induced by PVE and in guaranteeing good liver function before major hepatectomy.
Authors: N A van der Gaag; J J Kloek; S M M de Castro; O R C Busch; T M van Gulik; D J Gouma Journal: J Gastrointest Surg Date: 2008-08-23 Impact factor: 3.452
Authors: Jaap J Kloek; Niels A van der Gaag; Yalda Aziz; Erik A J Rauws; Otto M van Delden; Johan S Lameris; Olivier R C Busch; Dirk J Gouma; Thomas M van Gulik Journal: J Gastrointest Surg Date: 2009-09-15 Impact factor: 3.452