[Is intrahepatic cholangiojejunostomy in liver hilus-localized malignant occlusive jaundice a better alternative to endoscopic transhepatic drainage?]

The malignant obstruction of the hepatic confluence has a poor prognosis and no chance of cure. Therefore the therapy of choice today is usually a transpapillary drainage and surgical interventions are avoided. Before the indication for a transhepatic drainage is established the malignant etiology of this disease should be verified in every case and inoperability should be cleared in case of doubt by laparotomy. In a few cases a curative resection is possible. From January 1st, 1979 to September 1st, 1986 we succeeded in a curative resection in one out of fourteen cases; in thirteen cases an intrahepatic cholangio-enterostomy, eleven times with the left intrahepatic duct and two times with the right intrahepatic duct, was performed. Though the rate of postoperative complication was 54%, in hospital mortality was only 7%. The curatively operated woman is now living for six years postoperatively and the man with a benign intrahepatic stricture after right hepatectomy because of hepatocellular cancer is now living 44 months after the first operation. The mean survival time of the palliative operated patients is 12.3 months. Thus the intrahepatic cholangio-enterostomy seems to be superior to the endoscopic transpapillary drainage in comparable cases of tumor obstruction of the hepatic confluence concerning life quality and life expectancy.