Intrahepatic biliary-intestinal bypass in malignant jaundice

There is still dispute as to the best treatment for obstructive jaundice of malignant origin when the bile ducts are blocked high in the porta hepatis. Intrahepatic duct-to-jejunal anastomoses provide a surgical solution which frees the patient from the need to wear external appliances. A series of eight patients having such anastomoses have been studied to determine the adequacy of bilirubin clearance, the durability of relief from jaundice, the length of hospital stay, the operative mortality and survival from the time of surgery. Intrahepatic bypasses were shown to allow bilirubin clearance in the lower range of normal. Freedom from jaundice persisted until death at a median time of 5 months from operation. Cholangitis was not a problem in any patient postoperatively. There was only one operative death. The major disadvantage of the technique arose from the hospital stay, a median of 30 days. It is suggested that all these factors should be considered in studies to compare surgical bypass with endoscopic or percutaneous methods for the relief of malignant jaundice.