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Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction
Published on: March 25, 2022
Surgical biliary bypass for benign and malignant extrahepatic biliary tract disease
R W Parks1, G W Johnston, B J Rowlands
1Professorial Surgical Unit, Royal Victoria Hospital, Belfast, UK.
Insights
Surgical biliary bypass offers safe and effective management for both benign and malignant extrahepatic biliary tract diseases. This procedure shows comparable morbidity and mortality rates, making it a viable option for patients requiring intervention.
Area of Science:
- Hepatobiliary Surgery
- Surgical Oncology
- Gastroenterology
Background:
- Optimal management for extrahepatic biliary tract diseases is debated.
- Surgical biliary bypass is a key intervention for these conditions.
Purpose of the Study:
- To evaluate the outcomes of surgical biliary bypass in patients with benign and malignant extrahepatic biliary tract disease.
- To compare morbidity and mortality rates between benign and malignant disease groups.
Main Methods:
- Retrospective review of 121 patients undergoing surgical biliary bypass over 9 years.
- Patients were categorized into benign (60) and malignant (61) disease groups.
Main Results:
- No significant difference in 30-day mortality (2% vs. 8%, P=0.22) or early/late morbidity (13% vs. 21%, P=0.36; 20% vs. 25%, P=0.70) between benign and malignant groups.
- Median postoperative stay was 10 days for both groups.
- Median survival for malignant disease was 7 months, with significantly longer survival for cholangiocarcinoma (18 months) vs. pancreatic carcinoma (6.5 months, P<0.01).
Conclusions:
- Surgical biliary bypass is associated with acceptable morbidity and mortality rates.
- It should be considered for all patients with malignant extrahepatic biliary tract disease.
- Non-operative procedures are suitable alternatives for advanced malignancy or unfit patients.
Background:
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.
Methods:
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.
Results:
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).
Conclusion:
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.
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