Surgical palliation for malignant obstructive jaundice:our experience

BACKGROUND): The prognosis of patlcnts with priimsrv bilian and pancreatic mahgnances is poor. At the time of diagnosis, approxiiuately $0°’ of paticnts are found to hae an nnresectable tumour, because of local sprcad or metastatic disease. ‘lherefore, most patients wilI undergo j,alhative treatment, which is amcd at the ilnprovetnent ofthe quality oflife and the prevention of the svmptoms. This study report personal experience and deserihes the bcst evidence in recent literature.PA’IIENThAND METIIO1)S: 20 paticnts with malignant obstructie jaundice for unresectable hihar or pancreatic neoplasm underwent palliative surgieal treatment. Ofthesc patients, 11 was nien and 9 women, with a mean age of 68 ears (range SO 87 years). ‘fhirtcen patients was affected hy cancer of the head of the pancreas, 5 biliarv neoplasm and 2 ainpuflarv neoplasnis.A hepaticojejunostomy was performed In 16 patients, and in 4 patients a cholecistojejunostomy. Moreover, all patients had a gastrojejunostomy with oniega loop for digestive bv-pass.RES12LTS: Nohody had relapse ofobstructive jaundice or obstruction ofintestinal transit and the median survival was 8 tnonth (range 6-13 months). Morhidit’ and niortalitv was 10% and 5%.CONCHJSIONS: The Autors believe that botti youngcr patients, botti these wh() are free from major co-morbidity and also with an cxpectation oflife more than 6 mounth, have betterpalliation by surgery than endoscopy. The better sur - gical approach is side-to-side hepaticojejunostomv fashioned as proximal as possible using a Roux en Yliinb ofproximal jejunum. Moreover, all pacients who are treatcd with open surgical hiharv bvpass should also have a prophylactic gastrojejunostotny