title: Biliary bypass surgery - Analysis of indications & outcome of different procedures.
abstract: OBJECTIVE
  This study reports the indications and outcome of various biliary bypass surgical procedures from a single centre over a period of 10 years.
  
  
  METHODS
  This is a prospective observational study conducted over a period of 10 years (January 2001-december 2010). A total of 1500 patients were included, who underwent pancreatico-biliary surgery due to common bile duct (CBD) stones, congenital anomalies of biliary tree, unoperable pancreatico-biliary malignancies, CBD strictures and cases who developed iatrogenic biliary injuries during cholecystectomy (both open & laproscopic) during this period of time. The patients who required biliary bypass surgery were further analysed for indications and outcome.
  
  
  RESULTS
  Out of 1500 patients 83(5.53%) required biliary bypass surgical procedures. The CBD stones were observed as the most common indication (25.3%), followed by CBD injuries after open(10.84%) or laproscopic-cholecystectomy (14.46%), carcinoma head of pancreas (12.05%) and CBD obstruction(14.46%) either due to CBD strictures or unknown distal obstruction. Roux-en-Y-hepatico-jejunostomy (26.51%) was the most frequently performed procedure, followed by choledochoduodenostomy and Roux-en-Y choledocho-jejunostomy (i.e. 25.3% and 12.05% respectively). Roux-en-Y biliary bypass procedure was observed to be associated with better outcome in terms of rate of complications as well duration of hospital stay.
  
  
  CONCLUSIONS
  Biliary bypass surgical procedures are the better options to restore the continuity of biliary system in patients with iatrogenic biliary tree injuries and un-operable pancreatico-biliary malignancy. Roux-en-Y biliary bypass procedure is safe and problem solving method in these cases.
authors.affiliation: K.Altaf Hussain Talpur, Liaquat University of Medical & Health Sciences (LUMHS), Jamshoro/Hyderabad, Sindh, Pakistan.
authors.forename: K Altaf
authors.initials: KA
authors.lastname: Hussain Talpur
authors.affiliation: Arshad Mahmood Malik, Liaquat University of Medical & Health Sciences (LUMHS), Jamshoro/Hyderabad, Sindh, Pakistan.
authors.forename: Arshad
authors.initials: A
authors.lastname: Mahmood Malik
authors.affiliation: Amir Iqbal Memon, Liaquat University of Medical & Health Sciences (LUMHS), Jamshoro/Hyderabad, Sindh, Pakistan.
authors.forename: Amir
authors.initials: A
authors.lastname: Iqbal Memon
authors.affiliation: Jawed Naeem Qureshi, Liaquat University of Medical & Health Sciences (LUMHS), Jamshoro/Hyderabad, Sindh, Pakistan.
authors.forename: Jawed
authors.initials: J
authors.lastname: Naeem Qureshi
authors.affiliation: Ahmed Khan Sangrasi, Liaquat University of Medical & Health Sciences (LUMHS), Jamshoro/Hyderabad, Sindh, Pakistan.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Khan Sangrasi
authors.affiliation: Abdul Aziz Laghari, Liaquat University of Medical & Health Sciences (LUMHS), Jamshoro/Hyderabad, Sindh, Pakistan.
authors.forename: Abdul Aziz
authors.initials: AA
authors.lastname: Laghari
keywords: Biliary bypass surgery; Biliary injuries; CBD stones; Cholecystectomy; Pancreatico-biliary malignancies