[Simplified combination bypass or biliodigestive anastomosis alone in nonresectable carcinoma of the head of the pancreas?].
Between January 1, 1986 and December 31, 1992 93 patients with irresectable carcinoma of the pancreatic head underwent surgical palliation: In group I (n = 51) a single loop biliary (BB)- and gastric bypass (GB) was performed. 34 times the gastrojejunostomy was performed prophylactically. In group II (n = 42) surgical palliation was carried out only by biliary decompression in Roux-Y technique. In 30.9% gastric outlet obstruction (GOO) developed during follow-up. Both groups were comparable according to effectiveness of biliary drainage (93% (n = 42) (I); 97% (n = 38) (II)) with median post-operative bilirubin levels of 3.21 mg/dl (I) and 4.1 mg/dl (II). Cholecysto-choledocho- and hepaticojejunostomy were equally effective. Median operative time, morbidity (19.6 (I) vs. 26.2 (II)) and postoperative hospitalization were similar. Since there is a high frequency of secondary GOO after single BB we think that GB should be performed in all patients that undergo BB because secondary gastrojejunostomy at a later stage significantly increases morbidity and mortality.
Hehl
A J
AJ
Klinik für Allgemein- und Abdominalchirurgie, Zentralklinikum Augsburg.
Lindemann
F
F
Witte
J
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000713:Anastomosis, Roux-en-Y / Q000379:methods*; D000714:Anastomosis, Surgical / Q000379:methods*; D001652:Bile Ducts / Q000601:surgery*; D002423:Cause of Death; D001651:Cholestasis, Extrahepatic / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007582:Jejunostomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality; D012189:Retrospective Studies; D015996:Survival Rate