Major liver resection without preoperative biliary drainage in jaundiced patients with hilar biliary obstruction

The need for routine use of preoperative biliary drainage (PBD) for major liver resection in jaundiced patients has recently been questioned.

We present our experience of 22 consecutive patients with hilar biliary obstruction who underwent major liver resection without PBD between January 2007 and January 2011.

Twenty-two patients with hilar biliary obstruction underwent major liver resection without PBD over a 4-year period; nineteen had malignant and 3 benign hilar strictures. Fifteen patients underwent right hepatectomy (7) or right trisectionectomy (8) and seven underwent left hepatectomy. Segment 4a was spared in all patients who underwent right trisectionectomy. Six patients had concomitant portal vein resection. Fourteen patients had varying degrees of lobar atrophy. The median preoperative bilirubin was 18 mg % (range 9.1 to 27 mg %). The median blood transfusion requirement was 2 units (range 1–6). There was one postoperative death from portal vein thrombosis. Three patients who underwent greater than 50 % resection developed postoperative ascites.

Major liver resection leaving a liver remnant of 50 % is safe in jaundiced patients without PBD even when portal vein reconstruction is necessary. PBD should be used selectively.