Intrahepatic anastomoses for malignant and benign biliary obstruction

Area of Science:

• Hepatobiliary surgery
• Surgical oncology
• Gastroenterology

Background:

• Hilar biliary obstruction presents significant surgical challenges.
• Intrahepatic bilioenteric anastomoses are complex procedures.
• Outcomes of these anastomoses require thorough evaluation.

Purpose of the Study:

• To evaluate the role, techniques, and outcomes of intrahepatic bilioenteric anastomoses.
• To assess the efficacy of these anastomoses in palliative and curative settings for hilar malignancies.
• To compare outcomes between palliative, curative, and benign disease groups.

Main Methods:

• Retrospective review of 59 patients undergoing intrahepatic bilioenteric anastomoses over 23 years.
• Analysis of surgical techniques, hospital mortality, and long-term follow-up.
• Assessment of biochemical markers (bilirubin, alkaline phosphatase), stenosis, cholangitis, and survival rates.

Main Results:

• Hospital mortality was observed in 6 (palliative) and 4 (curative) patients.
• Significant reductions in serum bilirubin and alkaline phosphatase were noted post-surgery (P < .5).
• High rates of recurrent stenosis (100% palliative, 69% curative) and cholangitis (37 patients) were observed. Median survival was 6 months (palliative) and 21.7 months (curative).

Conclusions:

• Intrahepatic anastomoses remain the sole curative treatment for obstructing hilar malignant disease.
• Despite recurrence challenges, these procedures offer a chance for cure in selected patients.
• Modern endoscopic and percutaneous techniques do not replace the role of surgical anastomoses in these cases.