[Segmental bile duct bypass in obstruction of the liver hilus: only an alternative?]

Between 1987 and 1992 unilateral, segmental bilioenteric bypass-procedures (30 round ligament approach procedures, 4 peripheral bypass-procedures to the segment III bile duct and 3 to the segment V bile duct) were carried out in 37 icteric patients (twenty cholangio-carcinomas, 8 gallbladder-carcinomas, 6 other malignomas, 3 benign strictures). Postoperative complications were seen in 17 (46%) patients. The 30 day mortality rate was 3% (1/37). Relief of symptoms were achieved in 83% of patients. Objectively there was a significant postoperative reduction of serum bilirubin levels from mean 323 mumol/l to 109 mumol/(p < 0.005) and of the alkaline phosphatase from 708 U/l to 336 U/l (p < 0.005) respectively. This was achieved irrespectively of whether the segmental bypass was draining a segment only or the whole liver. Unilateral segmental bilioenteric bypass-procedures achieve an effective palliation in the majority of patients.