title: Combined biliary and gastric bypass procedures as effective palliation for unresectable malignant disease.
abstract: BACKGROUND
  Although endoscopic treatment of jaundice is increasingly used in the palliation of unresectable malignant disease, surgical bypass still has a role to play in this setting. This study aimed to reappraise the short-term and long-term results of combined biliary/gastric bypass (hepaticojejunostomy and gastrojejunostomy) as palliation for unresectable malignant disease.
  
  
  METHODS
  All patients undergoing simultaneous biliary and gastric bypass procedures for unresectable malignant disease between August 2000 and January 2006 were identified and outcomes reviewed.
  
  
  RESULTS
  One hundred and two patients underwent open surgical biliary drainage procedures for palliation of malignant disease. Underlying malignant disease included pancreatic carcinoma (n = 88), duodenal adenocarcinoma (n = 6) and distal cholangiocarcinoma (n = 3). Thirty-one of the patients underwent a planned palliative bypass procedure, the remainder being carried out after unresectable disease was identified at laparotomy. Postoperative mortality and morbidity rates were higher in the group undergoing planned bypass. During follow up, two patients developed recurrent jaundice that required transhepatic stenting and two patients developed late gastric outlet obstruction requiring refashioning of the gastrojejunostomy.
  
  
  CONCLUSIONS
  Combined surgical biliary and gastric bypass achieved effective palliation of jaundice and gastric outlet obstruction until death in >95% of patients in this series. It remains first-line therapy in patients identified as having unresectable disease at laparotomy.
authors: Department of Hepatobiliary and Pancreatic Surgery, University Hospitals of Leicester, Leicester General Hospital, Leicester, England, UK. chris.mann@doctors.org.uk
authors: Christopher D
authors: CD
authors: Mann
authors: Sarah C
authors: SC
authors: Thomasset
authors: Nicholas A
authors: NA
authors: Johnson
authors: Guiseppe
authors: G
authors: Garcea
authors: Christopher P
authors: CP
authors: Neal
authors: Ashley R
authors: AR
authors: Dennison
authors: David P
authors: DP
authors: Berry
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001662:Biliary Tract Surgical Procedures / Q000379:methods*; D018281:Cholangiocarcinoma / Q000601:surgery; D004379:Duodenal Neoplasms / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000009:adverse effects*; D005774:Gastrostomy; D006801:Humans; D007582:Jejunostomy; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods; D010190:Pancreatic Neoplasms / Q000601:surgery*; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome