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Combined biliary and gastric bypass procedures as effective palliation for unresectable malignant disease
Author(s) -
Mann Christopher D.,
Thomasset Sarah C.,
Johnson Nicholas A.,
Garcea Guiseppe,
Neal Christopher P.,
Dennison Ashley R.,
Berry David P.
Publication year - 2009
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/j.1445-2197.2008.04798.x
Subject(s) - medicine , gastric outlet obstruction , laparotomy , jaundice , surgery , palliative care , adenocarcinoma , biliary disease , gastric bypass , disease , endoscopic stenting , gastroenterology , general surgery , endoscopy , cancer , weight loss , nursing , obesity
Background: Although endoscopic treatment of jaundice is increasingly used in the palliation of unresectable malignant disease, surgical bypass still has a role to play in this setting. This study aimed to reappraise the short‐term and long‐term results of combined biliary/gastric bypass (hepaticojejunostomy and gastrojejunostomy) as palliation for unresectable malignant disease. Methods: All patients undergoing simultaneous biliary and gastric bypass procedures for unresectable malignant disease between August 2000 and January 2006 were identified and outcomes reviewed. Results: One hundred and two patients underwent open surgical biliary drainage procedures for palliation of malignant disease. Underlying malignant disease included pancreatic carcinoma ( n = 88), duodenal adenocarcinoma ( n = 6) and distal cholangiocarcinoma ( n = 3). Thirty‐one of the patients underwent a planned palliative bypass procedure, the remainder being carried out after unresectable disease was identified at laparotomy. Postoperative mortality and morbidity rates were higher in the group undergoing planned bypass. During follow up, two patients developed recurrent jaundice that required transhepatic stenting and two patients developed late gastric outlet obstruction requiring refashioning of the gastrojejunostomy. Conclusion: Combined surgical biliary and gastric bypass achieved effective palliation of jaundice and gastric outlet obstruction until death in >95% of patients in this series. It remains first‐line therapy in patients identified as having unresectable disease at laparotomy.