Patients with obstructive jaundice are prone to recurrent cholangitis, sepsis, bacterial translocation, impaired 
mononuclear phagocytic as well as intestinal barrier and renal functions. Pre-operative biliary drainage can lower serum 
endotoxins and improve mononuclear phagocytic functions. 
A retrospective evaluation of the results of surgery after endoscopic biliary drainage was made for 86 patients with 
surgical obstructive jaundice seen in the last five years at Theodor Bilharz Research Institute. Median follow up was 30 
months. 
Endoscopic retrograde cholangiopancreatography (ERCP) and stent insertion were successful with a progressive relief of 
jaundice and cholestasis in 65 (75.6%) and could not be achieved in 21 (24.4%) patients because of complete interruption of the
biliary tree in 12 (13.9%) or failed stenting in 9 (10.5%) patients. Complications following ERCP and stent insertion had 
occurred in 5 (6%) patients including one fatal cholangitis with Charcot's pentad. 
Unsettling calcular and malignant obstructive jaundice were seen in 43 (50%) and 21 (24.4%) patients respectively. 
Iatrogenic biliary injuries, resulting in complete bile ducts interruption or stricture, and benign biliary stricture, due to 
chronic pancreatitis were found in 12 (14%), 4 (4.65%) and 2 (2.3%) patients respectively. In addition, 4 (4.65%) patients had 
rare causes of obstructive jaundice. 
Postoperative relief of jaundice was achieved in all patients (80 patients), early and late morbidities due to wound 
infection (8 patients, 10%), stomal stenosis after the first year (one patient, 1.25%) and recurrent cholangitis (2 patients, 2.5%) 
were respectively observed. There was no operative death. 
In conclusion, endoscopic stenting followed by timed surgery is believed to be the optimum treatment for surgical 
obstructive jaundice.