End-to-end duodenojejunal bypass for unresectable periampullary carcinoma.
Palliative operation plays an important part in the treatment of periampullary carcinoma. However, gastric bypass such as the widely practiced side-to-side gastrojejunostomy frequently fails to provide adequate drainage. Here we attempted to fashion an end-to-end duodenojejunostomy in the hope of establishing physiological continuity of the stomach and duodenum. Biliary bypass with side-to-side choledochojejunostomy is performed simultaneously. Eight patients underwent this surgery. In seven of these, radical resection proved to be impossible, and in one the duodeno-biliary decompression was attempted before the radical operation. Early results were satisfactory in all patients. They began to eat liquid meals within a week, and were discharged uneventfully within the third postoperative week, when they were able to eat a regular diet. No ulcer developed in any of the patients. Plasma gastrin levels following a test meal was significantly lower after the operation, but plasma CCK-N and GIP levels showed no statistical difference prior to and after surgery. This duodenojejunal bypass is recommended as a means of improving the quality of the remaining life of the patients.
Kajiwara
T
T
First Department of Surgery, Kobe City General Hospital, Japan.
Fukuhara
T
T
Okuno
T
T
Hashimoto
T
T
Takamine
Y
Y
Konishi
Y
Y
Tani
T
T
D000368:Aged; D014670:Ampulla of Vater; D015904:Biliopancreatic Diversion; D002768:Choledochostomy; D003138:Common Bile Duct Neoplasms / Q000097:blood / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D004385:Duodenostomy / Q000379:methods*; D005260:Female; D005746:Gastric Emptying; D005749:Gastric Inhibitory Polypeptide / Q000097:blood; D005755:Gastrins / Q000097:blood; D005772:Gastrointestinal Transit; D006801:Humans; D007582:Jejunostomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D010190:Pancreatic Neoplasms / Q000097:blood / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D011182:Postoperative Care; D012844:Sincalide / Q000097:blood; D015996:Survival Rate
D005755:Gastrins; D005749:Gastric Inhibitory Polypeptide; D012844:Sincalide