title: [Stent or surgical bypass as palliative therapy in obstructive jaundice].
abstract: During the last decades, the mortality following pancreatic resections has decreased tremendously due to advances in operative technique and perioperative management. In order to examine if similar improvements have been achieved for surgical palliation of obstructive jaundice, we conducted an analysis of our series of surgical bypass procedures.
  
  
  METHODS
  Data from all patients undergoing surgical palliation after exploration for pancreatic carcinoma, were prospectively recorded.
  
  
  RESULTS
  Between 1.11.93 to 1.11.99 a total of 348 patients were treated with a tumor of the pancreas. 74 of these patients received a bypass procedure: there were 40 double bypass, 20 biliary and 14 gastric bypass procedures. Overall morbidity and mortality was 35% and 1.2% respectively. Median in-hospital stay was 12 days (range 6-37). Median survival time was 5 months (range 1-25). Neither the type of surgical palliation, age nor perioperative risk assessment according to the ASA classification affected perioperative mortality. In contrast, jaundiced patients had significantly more postoperative complications than non-jaundiced patients (58% versus 18%; p = 0.001).
  
  
  CONCLUSIONS
  Surgical palliation can nowadays be performed with great safety. A double bypass procedure consisting of a hepatojejunostomy combined with a gastrojejunostomy seems to be the procedure of choice for patients with unresectable pancreatic carcinoma.
authors.affiliation: Klinik für Visceral- und Transplantationschirurgie, Inselspital Bern, Schweiz.
authors.forename: M
authors.initials: M
authors.lastname: Wagner
authors.forename: B
authors.initials: B
authors.lastname: Egger
authors.forename: C
authors.initials: C
authors.lastname: Kulli
authors.forename: C A
authors.initials: CA
authors.lastname: Redaelli
authors.forename: L
authors.initials: L
authors.lastname: Krähenbühl
authors.forename: C A
authors.initials: CA
authors.lastname: Seiler
authors.forename: M W
authors.initials: MW
authors.lastname: Büchler
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001651:Cholestasis, Extrahepatic / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D007582:Jejunostomy / Q000379:methods; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000601:surgery*; D011446:Prospective Studies; D015607:Stents; D015996:Survival Rate