Indications for gastric bypass in palliative operations for pancreatic carcinoma

This review was undertaken to determine whether there are specific factors which predict the development of gastric outlet obstruction (GOO) in patients with pancreatic carcinoma. One hundred forty-two patients with biopsy proven pancreatic carcinoma had palliative operations of whom 74 had gastric bypass (GB). Of the 68 who did not, four died after biliary bypass. The 64 patients who remained at risk for GOO are the subject of this report. Seven of those patients developed GOO in the postoperative period and were compared with the 57 who did not. No significant difference was found between the two groups when they were compared on the basis of 20 historic, laboratory, and operative finding criteria. These data indicate that accurate prediction of subsequent GOO is not possible based on available objective data. Because GB creation does not increase operative blood loss, operative time, postoperative stay, or postoperative morbidity, and because prediction of need is difficult, prophylactic GB should be applied very liberally.