title: Initial and long-term outcome after palliative surgical drainage of 269 patients with malignant biliary obstruction.
abstract: OBJECTIVE
  This study aimed to analyse the current outcome after palliative surgical drainage of malignant biliary obstruction.
  
  
  METHODS
  From 1992 to 2003, perioperative parameters and the incidence and indications of readmissions were analysed in 269 patients who underwent a palliative biliary bypass for periampullary carcinoma.
  
  
  RESULTS
  Hospital mortality occurred in seven patients and median postoperative stay was 10 days. Anastomotic leakage occurred in three patients and intraabdominal haemorrhage in eight patients. Overall 75 patients experienced a complication. Nine patients underwent a relaparotomy during initial hospital admission. Overall, 142 patients were readmitted, 13 for indications related to the biliary bypass, 11 for surgery-related indications. Twenty-five patients were readmitted for radiochemotherapy, 112 for progressive disease and 23 for indications not related to the disease. Median survival was 7.5 months and the 3-year survival 3%. Survival was significantly lower in patients with metastases and in those who underwent elective bypass for gastric outlet obstruction.
  
  
  CONCLUSIONS
  Current hospital mortality after palliative biliary bypass as well as readmission rates for complications related to the biliary bypass or surgical procedure are low. Surgical biliary bypass is a safe and effective palliative treatment for patients with malignant biliary obstruction.
authors.affiliation: Department of Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
authors.forename: K F D
authors.initials: KF
authors.lastname: Kuhlmann
authors.forename: D
authors.initials: D
authors.lastname: van Poll
authors.forename: S M M
authors.initials: SM
authors.lastname: de Castro
authors.forename: N T
authors.initials: NT
authors.lastname: van Heek
authors.forename: O R C
authors.initials: OR
authors.lastname: Busch
authors.forename: T M
authors.initials: TM
authors.lastname: van Gulik
authors.forename: H
authors.initials: H
authors.lastname: Obertop
authors.forename: D J
authors.initials: DJ
authors.lastname: Gouma
mesh_terms: D014670:Ampulla of Vater / Q000601:surgery*; D000714:Anastomosis, Surgical / Q000009:adverse effects; D002277:Carcinoma / Q000150:complications*; D017024:Chemotherapy, Adjuvant; D001651:Cholestasis, Extrahepatic / Q000209:etiology / Q000601:surgery*; D003137:Common Bile Duct Diseases / Q000209:etiology / Q000601:surgery*; D003138:Common Bile Duct Neoplasms / Q000150:complications*; D018450:Disease Progression; D004322:Drainage; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D007813:Laparotomy; D007902:Length of Stay; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D010359:Patient Readmission; D019106:Postoperative Hemorrhage / Q000209:etiology; D018714:Radiotherapy, Adjuvant; D012086:Reoperation; D015996:Survival Rate; D016896:Treatment Outcome