Laparoscopic cholecyst-jejunostomy and gastroenterostomy for malignant disease

The technique of videolaparoscopic surgical bypass for malignant obstruction of the distal common bile duct and duodenum is described as it has evolved since 1991. The techniques available include anastomosis of jejunum to the gallbladder and stomach by suture, staples or a combination of the two techniques. The present criteria for patient selection for these palliative approaches, alone or in combination with ERCP stenting, are discussed. Early clinical experience in several small series of patients treated by this laparoscopic approach suggests rapid recovery will be added to the proven reliability of these open palliative bypass techniques.