Effectiveness of peripheral hepatogastrostomy versus hepatojejunostomy in the treatment of obstructive cholestasis: results of an experimental model.
OBJECTIVE
Tumors of the liver hilum frequently cause obstructive cholestasis. When a curative resection of the tumor is impossible, palliative bile drainage is indicated. A hepatojejunostomy is performed if conservative treatment fails or if irresectability is proven during an initial laparotomy. In patients with peritoneal carcinosis and mesentery retraction, a hepatogastrostomy may represent a helpful alternative. An experimental study was designed to compare the bile drainage effectiveness of a hepatogastrostomy versus a hepatojejunostomy.


METHODS
Two-month-old outbred piglets were used in all experiments. The animals were randomized into three groups (hepatojejunostomy, hepatogastrostomy alone, hepatogastrostomy and proton pump inhibitors). Obstructive cholestasis was induced by common bile duct ligation; hepatojejunostomy and hepatogastrostomy were performed 2 weeks later. The serum bilirubin levels were monitored weekly. All animals were killed 4 weeks after the drainage operation.


RESULTS
Following a hepatojejunostomy (n = 5) all animals showed decreasing cholestasis parameters. All animals (n = 3) died within 3-5 days after a hepatogastrostomy due to gastrointestinal bleeding caused by gastric ulcers and ulcers of the liver surface. The administration of pantoprazole prevented these bleeding complications. In animals treated by hepatogastrostomy and proton pump inhibitors (n = 5), bile drainage effectiveness was similar to that following hepatojejunostomy.


CONCLUSIONS
A hepatogastrostomy represents an alternative treatment option for surgical bile drainage with a similar effectiveness to that of a hepatojejunostomy. To prevent postoperative gastrointestinal bleeding, proton pump inhibitors should be used.
Dahlke
Marc H
MH
Department for Hepatobiliary Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia.
Aselmann
Heiko
H
Ceylan
Dilek
D
Bellin
Tobias
T
Flemming
Peer
P
Meier
Peter N
PN
Oldhafer
Karl
K
Klempnauer
Juergen
J
Schlitt
Hans J
HJ
Piso
Pompiliu
P
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000818:Animals; D001562:Benzimidazoles / Q000627:therapeutic use; D002779:Cholestasis / Q000601:surgery*; D003135:Common Bile Duct; D005240:Feasibility Studies; D005774:Gastrostomy; D017506:H(+)-K(+)-Exchanging ATPase / Q000627:therapeutic use; D007582:Jejunostomy; D008099:Liver / Q000601:surgery*; D009853:Omeprazole / Q000031:analogs & derivatives; D000077402:Pantoprazole; D013454:Sulfoxides / Q000627:therapeutic use; D013552:Swine; D016896:Treatment Outcome
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D001562:Benzimidazoles; D013454:Sulfoxides; D000077402:Pantoprazole; D017506:H(+)-K(+)-Exchanging ATPase; D009853:Omeprazole