title: [Contemporary surgical treatment for unresectable periampullary tumors. Double or tripple by-pass surgery].
abstract: OBJECTIVE
  Pancreatic neoplasms continues to be a highly lethal disease with poor prognosis. This single-institution experience reviews the palliative surgical techniques used in a group of patients with periampullary tumors accenting to a technique of pancreato-wirsungo-jejunostomy, protesed with "perdue"-drain and combined with gastroenterostomy.
  
  
  METHODS
  For the period of 01.01.2006-31.12.2007 in the Clinic of General and Liver-Pancreatic Surgery of University Hospital "Alexandrovska" are operated 162 patients with pancreatic cancer. 113 of them are with periampullary localization of the tumor, 49 are with localization at the body or at the tail of pancreatic gland. In 97 of the cases a different palliative procedures was performed. In two cases the technique of pancreato-wirsungo-jejunostomy, protesed with "perdue"-drain and combined with gastroenterostomy was performed.
  
  
  RESULTS
  The levels of the postoperative mortality and morbidity in patients with palliative surgical procedures are 6.2%, respectively 39.2%. The level of early pastoperative morbidity and mortality in cases with pancreato-wirsungo-jejunostomy, protesed with "perdue"-drain and combined with gastroenterostomy is 0%.
  
  
  CONCLUSIONS
  For patients with advanced periampullary malignacies, the prevention and alleviation of suffering due to obstructive jaundice, gastric outlet obstruction, cancer-related pain and pancreatic exocrine insufficiency is of primary importance. We think that the operative technique is represented by us useful often at patients with chronic pancreatitits, but the tehnique will be useful in given conditions for patients with unresectable periampullar pancreatic neoplasms.
authors.forename: A
authors.initials: A
authors.lastname: Jonkov
authors.forename: S
authors.initials: S
authors.lastname: Bonev
authors.forename: D
authors.initials: D
authors.lastname: Bulanov
authors.forename: E
authors.initials: E
authors.lastname: Tosheva
authors.forename: G
authors.initials: G
authors.lastname: Kolchagov
authors.forename: V
authors.initials: V
authors.lastname: Dimitrova
mesh_terms: D014670:Ampulla of Vater / Q000473:pathology / Q000601:surgery*; D003138:Common Bile Duct Neoplasms / Q000473:pathology / Q000601:surgery*; D005763:Gastroenterostomy; D006801:Humans; D010179:Pancreas / Q000473:pathology / Q000601:surgery*; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*