Laparoscopic treatment of biliary and gastric outlet obstruction

To avoid laparotomy in patients with biliary or gastric outlet obstruction in inoperable carcinoma of the pancreas, we evaluated the feasibility of double-bypass operation in 20 pigs. In model A (n = 10), biliary bypass was a Roux-en-Y loop for cholecystojejunostomy after choledochal clip occlusion. In model B (n = 10) an additional Roux-en-Y loop was attached to the stomach after transection of the duodenum. Model A showed functioning biliary bypass with patent and leak-free anastomoses at necropsy on day 28. In model B, four pigs were sacrificed earlier, but nine had normal functioning double bypass (two intussusceptions of the ileum, one bleeding ulcer at the gastroenterostomy, one necrotic Roux-en-Y-loop). Based on the presented bypass function, we are encouraged to perform laparoscopic biliary and gastroenteral bypass in humans to treat malignant jaundice and gastric outlet obstruction.