title: Laparoscopic perspectives for distal biliary obstruction.
abstract: BACKGROUND
  In patients affected by distal biliary obstruction deemed unsuitable for pancreatoduodenectomy, biliary diversion is the only proposable option. Defined goals of this treatment are: relief from jaundice preventing its related complications, reduction of in-hospital stay and adequate control of pain. Palliation can be obtained either by surgical or conservative procedures (endoscopic stenting or percutaneous treatment). Considering early complications' incidence, surgical approach has always been reserved for low surgical risk patients with longer survival perspectives, while recently developed long-lasting patency stents enlarged mini-invasive application resort. Comparative studies on these therapeutic options favour the conservative one in respect of conventional open surgery, but data on minimally invasive surgery to pursue palliative aims are lacking. We present our six-years casuistic and results referring to laparoscopic biliary diversions.
  
  
  METHODS
  We analyzed results obtained in distal biliary neoplastic obstruction management between December 2008 and November 2014. During this period, selected patients considered unsuitable for pancreatoduodenectomy were scheduled to receive a laparoscopic biliary decompression. Perioperative variables and 30-days postoperative outcomes have been prospectively collected.
  
  
  RESULTS
  In the six-years period, 12 patients affected by distal biliary neoplastic obstruction were submitted to laparoscopic palliative bypass. Four procedures were proposed for distal biliary cancer, one for advanced periampullary cancer and seven for pancreatic head cancer. Ten hepatico-jejunal bypasses and two choledochoduodenostomies have been performed. No conversions to open surgery were encountered in this series. Main operative time was 85 min, main blood loss was 75 ml and main hospitalization was 4.5 days. According to Clavien Dindo Classification one class II and one class IIIb complications occurred.
  
  
  CONCLUSIONS
  Although the restricted number of patients, our results suggest that laparoscopic biliary bypass could be a valid option in managing distal biliary obstructions, resulting in low perioperative morbidity, effective long term palliation of symptoms and improved quality of life.
authors.affiliation: Department of Surgery, POLL-ASL 5, La Spezia, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Berti
authors.affiliation: University of Turin, Department of Oncology, School of Medicine, "San Luigi Gonzaga" Teaching Hospital, Section of General Surgery, Orbassano, Turin, Italy. Electronic address: alessia.ferrarese@gmail.com.
authors.forename: Alessia
authors.initials: A
authors.lastname: Ferrarese
authors.affiliation: Department of Surgery, POLL-ASL 5, La Spezia, Italy.
authors.forename: Cosimo
authors.initials: C
authors.lastname: Feleppa
authors.affiliation: Department of Surgery, POLL-ASL 5, La Spezia, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Francone
authors.affiliation: University of Turin, Department of Oncology, School of Medicine, "San Luigi Gonzaga" Teaching Hospital, Section of General Surgery, Orbassano, Turin, Italy.
authors.forename: Valter
authors.initials: V
authors.lastname: Martino
authors.affiliation: Department of Surgery, POLL-ASL 5, La Spezia, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Bianchi
authors.affiliation: Department of Surgery, POLL-ASL 5, La Spezia, Italy.
authors.forename: Emilio
authors.initials: E
authors.lastname: Falco
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000150:complications; D002779:Cholestasis / Q000209:etiology / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D010166:Palliative Care / Q000379:methods; D010190:Pancreatic Neoplasms / Q000150:complications; D011788:Quality of Life
keywords: Distal biliary obstruction; Laparoscopy; Pancreas; Pancreas cancer