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Biliary enteric bypass for benign and malignant disease.

G V Aranha, R A Prinz, H B Greenlee

    The American Surgeon
    |July 1, 1987
    PubMed
    Summary

    Biliary enteric bypass procedures like choledochoduodenostomy (CDD) and cholecystojejunostomy (CDJ) effectively relieve distal common bile duct obstruction. These safe and reliable methods offer significant symptomatic improvement for patients with benign and malignant conditions.

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    Area of Science:

    • Gastroenterology
    • Surgical Oncology
    • Hepatobiliary Surgery

    Background:

    • Distal common bile duct obstruction presents a significant clinical challenge.
    • Benign and malignant diseases frequently cause distal common bile duct obstruction.
    • Biliary enteric bypass is a surgical option for palliation.

    Purpose of the Study:

    • To evaluate the efficacy and outcomes of biliary enteric bypass procedures.
    • To compare the success rates of different types of biliary enteric bypass.
    • To assess the safety and reliability of these procedures for distal common bile duct obstruction.

    Main Methods:

    • A retrospective analysis of 96 patients undergoing biliary enteric bypass between 1970 and 1984.
    • Procedures included cholecystoenterostomy (CCE), choledochoduodenostomy (CDD), and cholecystojejunostomy (CDJ).
    • Outcomes measured included operative mortality, morbidity, and symptomatic improvement (pain, sepsis, bilirubin, alkaline phosphatase).

    Main Results:

    • Overall symptomatic improvement was observed in 73% of patients.
    • Choledochojejunostomy (CDJ) showed a 65% improvement rate, while choledochoduodenostomy (CDD) had an 8% improvement rate.
    • Operative mortality was 7%, and morbidity was 12%. Poor results were predominantly seen in patients with advanced malignancy.

    Conclusions:

    • Choledochoduodenostomy (CDD) and cholecystojejunostomy (CDJ) are safe and effective for relieving distal common bile duct obstruction.
    • Cholecystojejunostomy (CDJ) is a viable option for palliative short-term bypass in terminal cancer patients.
    • Careful patient selection is crucial, especially for those with advanced malignancy.

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