Drenaje Biliar Selectivo o Total Para el Manejo de la Ictericia Obstructiva

Selective versus total biliary drainage for obstructive jaundice caused by a hepatobiliary malignancy
The American Journal Of Surgery 193(2):149-54
Takeaki Ishizawa M.D.a, Kiyoshi Hasegawa M.D., Ph.D.a, Keiji Sano M.D., Ph.D.a, Hiroshi Imamura M.D., Ph.D.a, Norihiro Kokudo M.D., Ph.D.a and Masatoshi Makuuchi M.D., Ph.D., a, aHepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.

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