[Neoplasms of the principal biliary passages]

The authors make an analysis of factors which led to a late diagnosis, and to the choice of various surgical procedures used in the treatment of neoplasms of the main biliary pathway. The classical picture of "nodose jaundice" was encountered in only 24% of the cases, and this explains the wrong interpretation of the jaundice etiology in the early stages. A series of diagnostic difficulties are stressed, especially during the surgical intervention, related to some macroscopic forms of the neoplasm, the localization in ares which are difficulty accessible, and the bioptic sampling which is only rarely possible. The advanced stage of the lesions explains the fact that therapeutic attempts were limited in 52% of all patients to laparotomy performed for exploratory purposes, while exeresis of the neoplastic formation was possible in only 3% of the cases. Palliative interventions were used in 45% of the cases. Trans-tumoral intubation was used for draining purposes in the internal derivations. This was applied in 9 cases since it is simple and easy to perform, providing results which are similar to those obtained with other types of derivations. When no such possibilities existed external draining of the bile was achieved, a minimal procedure which assured the solution for the jaundice problem.