title: The effect of communication between the right and left liver on the outcome of surgical drainage for jaundice due to malignant obstruction at the hilus of the liver.
abstract: Debate continues regarding the optimal management of irresectable malignant proximal biliary obstruction. Controversy exists concerning the ability of unilateral drainage to provide adequate biliary decompression with tumors that have occluded the communication between the right and left hepatic ductal systems. Between October 1986 and October 1989, 18 patients with malignant proximal biliary obstruction were treated by an intrahepatic biliary enteric bypass. Patients were divided into two groups based on the presence or absence of a communication between the right and left biliary systems. In Group I (n = 9), there was free communication; and in Group II (n = 9) there was no communication. There were two perioperative deaths (11%) one due to persistent cholangitis and the other to myocardial insufficiency both with one death in each group. The median survival (excluding perioperative deaths) was 5.6 months. Comparison of pre- and postoperative serum levels of bilirubin and alkaline phosphatase showed a significant decrease in each group, but no difference between the groups in the size of the reduction. Sixteen patients survived at least three months and the palliation was judged as excellent in eight, fair in five, and unchanged in three. These results demonstrate the effectiveness of biliary enteric bypass regardless of communication between the left and right biliary ductal systems.
authors.affiliation: Department of Visceral and Transplantation Surgery, University of Berne, Inselspital, Switzerland.
authors.forename: H U
authors.initials: HU
authors.lastname: Baer
authors.forename: M
authors.initials: M
authors.lastname: Rhyner
authors.forename: S C
authors.initials: SC
authors.lastname: Stain
authors.forename: P W
authors.initials: PW
authors.lastname: Glauser
authors.forename: A R
authors.initials: AR
authors.lastname: Dennison
authors.forename: G J
authors.initials: GJ
authors.lastname: Maddern
authors.forename: L H
authors.initials: LH
authors.lastname: Blumgart
mesh_terms: D000328:Adult; D000368:Aged; D000469:Alkaline Phosphatase / Q000097:blood; D000714:Anastomosis, Surgical / Q000379:methods*; D001650:Bile Duct Neoplasms / Q000150:complications; D001653:Bile Ducts, Intrahepatic / Q000473:pathology / Q000601:surgery; D001663:Bilirubin / Q000097:blood; D016022:Case-Control Studies; D018281:Cholangiocarcinoma / Q000150:complications; D002780:Cholestasis, Intrahepatic / Q000097:blood / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D003251:Constriction, Pathologic / Q000601:surgery; D004322:Drainage / Q000379:methods*; D005260:Female; D005706:Gallbladder Neoplasms / Q000150:complications; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000150:complications; D011182:Postoperative Care; D011183:Postoperative Complications / Q000453:epidemiology; D011300:Preoperative Care; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D000469:Alkaline Phosphatase; D001663:Bilirubin