Hepaticocholecystoduodenostomy compared with Roux-en-y choledochojejunostomy for decompression of the biliary tract

The nature of palliative decompressive surgery for unresectable periampullary tumor is usually determined by the experience of the surgeon. We compared hepaticocholecystoduodenostomy (HCD), a new palliative decompressive anastomotic technique, to Roux-en-y choledochojejunostomy (CDJ) in this prospective, randomized study.

Twenty patients who were to undergo surgery for palliative bypass were randomized into two groups: group I was subjected to HCD (10 patients) and group II to CDJ (10 patients). Pre- and postoperative liver function tests, operative time, operative blood loss, onset of postoperative enteral feeding, length of hospital stay and survival rates were compared in the two groups.

Effective surgical decompression was observed clinically as well as on analysis of pre- and postoperative liver function tests in both the groups. The results were statistically significant in favor of patients in group I when compared to those of group II with respect to operative time 84.7 (10.3) min vs 133.6 (8.9) min; P =<.0001), operative blood loss 137.8 (37.2) mL vs 201.6 (23.4) mL; P =.001), postoperative enteral feeding 3.3 (0.5) days vs 5.0 (0.7) days; P =<.0001) and length of hospital stay 7.5 (0.7) days vs 9.7 (1.2) days ; P =<.0001). During follow-up, recurrent jaundice was observed in one patient in group I and two patients in group II, while duodenal obstruction developed in one patient in the group I series. Gastrointestinal hemorrhage occurred in one patient belonging to group II. The difference in mean survival time was not statistically significant.

Based on this small series, HCD seems to be a better palliative surgical procedure than the routinely performed CDJ.