Hepaticocholecystoduodenostomy compared with Roux-en-y choledochojejunostomy for decompression of the biliary tract.
OBJECTIVE
The nature of palliative decompressive surgery for unresectable periampullary tumor is usually determined by the experience of the surgeon. We compared hepaticocholecystoduodenostomy (HCD), a new palliative decompressive anastomotic technique, to Roux-en-y choledochojejunostomy (CDJ) in this prospective, randomized study.


METHODS
Twenty patients who were to undergo surgery for palliative bypass were randomized into two groups: group I was subjected to HCD (10 patients) and group II to CDJ (10 patients). Pre- and postoperative liver function tests, operative time, operative blood loss, onset of postoperative enteral feeding, length of hospital stay and survival rates were compared in the two groups.


RESULTS
Effective surgical decompression was observed clinically as well as on analysis of pre- and postoperative liver function tests in both the groups. The results were statistically significant in favor of patients in group I when compared to those of group II with respect to operative time 84.7 (10.3) min vs 133.6 (8.9) min; P =<.0001), operative blood loss 137.8 (37.2) mL vs 201.6 (23.4) mL; P =.001), postoperative enteral feeding 3.3 (0.5) days vs 5.0 (0.7) days; P =<.0001) and length of hospital stay 7.5 (0.7) days vs 9.7 (1.2) days ; P =<.0001). During follow-up, recurrent jaundice was observed in one patient in group I and two patients in group II, while duodenal obstruction developed in one patient in the group I series. Gastrointestinal hemorrhage occurred in one patient belonging to group II. The difference in mean survival time was not statistically significant.


CONCLUSIONS
Based on this small series, HCD seems to be a better palliative surgical procedure than the routinely performed CDJ.
Shah
Omar
O
Department of Surgery, Sher-i-Kashmir Institute of Medical Science, Srinagar, Kashmir, India. omarjshah@yahoo.com
Shah
Parveen
P
Zargar
Showkat
S
D000368:Aged; D014670:Ampulla of Vater / Q000473:pathology; D000713:Anastomosis, Roux-en-Y / Q000379:methods*; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D002767:Cholecystostomy / Q000379:methods*; D002768:Choledochostomy / Q000379:methods*; D019299:Decompression, Surgical / Q000379:methods; D004379:Duodenal Neoplasms / Q000473:pathology / Q000601:surgery; D004385:Duodenostomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D015996:Survival Rate; D013997:Time Factors
Surg Laparosc Endosc. 1998 Apr;8(2):92-6
9566559
Am Surg. 1996 Jul;62(7):582-8
8651556
Surgery. 1982 Feb;91(2):123-33
6173929
Ann Surg. 2003 Jan;237(1):86-93
12496534
Cancer. 1996 Aug 1;78(3 Suppl):605-14
8681299
Am J Surg. 1993 Dec;166(6):632-6; discussion 636-7
7506010
Surg Endosc. 1993 Sep-Oct;7(5):416-9
8211620
Chirurgie. 1990;116(8-9):742-51
2129991
Ann Surg. 1998 Nov;228(5):652-63
9833803
Surg Gynecol Obstet. 1993 Jan;176(1):1-10
7678945
Surg Gynecol Obstet. 1981 May;152(5):597-600
6784258
Am J Surg. 1981 Apr;141(4):430-3
6164299
Arch Surg. 1987 Jul;122(7):827-9
2439057
Eur J Surg Oncol. 1993 Aug;19(4):342-7
7689488
Surg Endosc. 1997 Aug;11(8):834-7
9266646
Ann Oncol. 1999;10 Suppl 4:269-72
10436838
Am J Surg. 1988 Mar;155(3):411-4
3278638
Am J Surg. 1984 Mar;147(3):349-53
6199991
Ann Surg. 1990 Aug;212(2):132-9
1695834