Surgical biliary bypass for benign and malignant extrahepatic biliary tract disease

The optimal management of patients with benign and malignant disease affecting the extrahepatic biliary tract remains unresolved. A retrospective study was undertaken of all surgical biliary bypass procedures performed in one hepatobiliary unit.

A total of 121 patients treated in a 9-year period and comprising 60 patients with benign disease and 61 with malignant disease were reviewed.

There was no significant difference in 30-day mortality rate between patients with benign and malignant disease (2 versus 8 per cent respectively, P = 0.22). There was no significant difference between surgery for benign and malignant disease in early morbidity rate (13 versus 21 per cent respectively, P = 0.36) or late morbidity rate (20 versus 25 per cent, P = 0.70). The median postoperative stay in both groups of patients was 10 days. The median survival of all patients with malignant disease was 7 months, being significantly more favourable for those with cholangio-carcinoma (18 months) than for those with pancreatic carcinoma (6.5 months) (P < 0.01).

Biliary bypass procedures can be undertaken with acceptable rates of morbidity and mortality, and therefore should be considered in all patients with malignant disease of the extrahepatic biliary tract. If there is evidence of advanced malignancy, or if the patient is unfit for surgical intervention, non-operative procedures are a suitable alternative.