Mechanical biliary obstruction. A review of the multisystemic consequences of obstructive jaundice and their impact on perioperative morbidity and mortality.

Whether obstruction is due to malignancy (ampullary or pancreatic) or benign disease (stones or stricture), mechanical biliary obstruction (MBO) is not an uncommon disease. While the outward manifestations of the disease such as jaundice or inanition may be obvious, the specific effects of the obstructive process on liver parenchymal or ductular function are subtle and, as yet, ill-defined. There are, however, multiple recent reports in the literature suggesting that deep jaundice and its coincident disorders of hepatic, coagulation, renal, or immune function may be alleviated via percutaneous transhepatic drainage procedures. The purpose of this review are as follows: to outline the known consequences of MBO related to hepatic metabolic and secretory function; to describe the effects of MBO on organ systems other than the liver; to describe what tools are now available to quantitate the effects of MBO on liver function; and, finally, to present the evidence, either pro or con, that the relief of MBO via transhepatic drainage may affect perioperative morbidity and mortality in patients who undergo definitive procedure later in the course of their disease.