Several illnesses can cause an obstruction in the bile drainage system of the liver (obstructive jaundice). The most profound symptom is an elevated level of bilirubin (the 'dye' in the gall) in the blood causing the patient to appear yellow in the skin and eyes. Pre-operative biliary drainage is aimed at improving liver function of patients with obstructive jaundice. However, the potential benefit of pre-operative biliary drainage has not been clearly established. This review is important because it is the first of its kind to evaluate whether the pre-operative drainage is beneficial or not.
This review is based upon five trials with a total of 320 patients - 160 in each group, treatment and control. The present review found no evidence of any benefit of biliary drainage before surgery in patients with obstructive jaundice. In addition, increased hospital stay due to pre-operative biliary drainage adds to hospital costs. The bias risks of the included randomised trials were high and the total number of participants small. Therefore, systematic errors ('bias') and random errors ('play of chance') cannot be excluded. We need further trials on the topic. At present, biliary drainage before surgery in patients with obstructive jaundice cannot be recommended outside randomised clinical trials.
The trials this review is based upon are 7 to 14 years old, and for this reason alone further trials are needed. In the past decade, methodology of clinical trials has developed and new antibiotics have emerged. Today the outcome of a clinical trial might therefore be different.