Bypass operations for neoplastic biliary tract obstruction

Buckwalter, J. A.; Lawton, Richard L.; Tidrick, Robert T.

doi:10.1016/s0002-9610(65)80110-6

Cited by 75 publications

(11 citation statements)

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“…Mortality rates of between eight and 33% have been reported for surgery to relieve bile duct obstruction [13,16,17]. …”

Section: Discussionmentioning

confidence: 99%

“…The mortality and morbidity of biliary obstruction are dependent on the cause of the obstruction, and the assessment of any factors which influence the morbidity and mortality in patients with obstructive jaundice in each society is necessary [6,15]. It has been reported that obstructive jaundice continues to be associated with significant morbidity and mortality despite recent advances both in preoperative diagnosis and postoperative care [15-17]. Understanding factors responsible for increased morbidity and mortality in these patients will better guide appropriate management and lead to improved survival [17].…”

Section: Introductionmentioning

confidence: 99%

“…It has been reported that obstructive jaundice continues to be associated with significant morbidity and mortality despite recent advances both in preoperative diagnosis and postoperative care [15-17]. Understanding factors responsible for increased morbidity and mortality in these patients will better guide appropriate management and lead to improved survival [17]. …”

Section: Introductionmentioning

confidence: 99%

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Etiological spectrum and treatment outcome of Obstructive jaundice at a University teaching Hospital in northwestern Tanzania: A diagnostic and therapeutic challenges

2011

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BackgroundObstructive jaundice poses diagnostic and therapeutic challenges to general surgeons practicing in resource-limited countries. This study was undertaken to highlight the etiological spectrum, treatment outcome of obstructive jaundice in our setting and to identify prognostic factors for morbidity and mortality.MethodsThis was a descriptive prospective study which was conducted at Bugando Medical Centre between July 2006 and June 2010. All patients with a clinical diagnosis of obstructive jaundice were, after informed consent for the study, consecutively enrolled into the study. Data were collected using a pre-tested structured questionnaire and analyzed using SPSS computer software version 11.5.ResultsA total of 116 patients were studied. Females outnumbered males by a ratio of 1.3:1. Patients with malignant obstructive jaundice were older than those of benign type. Ca head of pancreas was the commonest malignant cause of jaundice where as choledocholithiasis was the commonest benign cause. Abdominal ultrasound was the only diagnostic imaging done in all patients and revealed dilated intra and extra-hepatic ducts, common bile stones and abdominal masses in 56.2%, 78.9%, 58.1% and 72.4% of the cases respectively. A total of 110 (94.8%) patients underwent surgical treatment and the remaining 6 (5.2%) patients were unfit for surgery. The complication rate was 22.4% mainly surgical site infections. The mean hospital stay and mortality rate were 14.54 days and 15.5% respectively. A low haematocrit and presence of postoperative sepsis were the main predictors of the hospital stay (P < 0.001), whereas age > 60 years, prolonged duration of jaundice, malignant causes and presence of postoperative complications mainly sepsis significantly predicted mortality (P < 0.001).ConclusionObstructive jaundice in our setting is more prevalent in females and the cause is mostly malignant. The result of this study suggests that early diagnosis and treatment plays an important role in the prognosis of patients with obstructive jaundice.

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“…Mortality rates of between eight and 33% have been reported for surgery to relieve bile duct obstruction [13,16,17]. …”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Etiological spectrum and treatment outcome of Obstructive jaundice at a University teaching Hospital in northwestern Tanzania: A diagnostic and therapeutic challenges

2011

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“…Moertel [36] has shown that biliary diversion combined with gastroenterostomy can result in increased survival. Several authors, however, report that surgical decompression of extrahepatic cholestasis due to malignant tumors may imply a high risk of operative mortality [37][38][39]. Coutsoftides et al [40] found that patients undergoing bypass did not live longer than those undergoing simple exploratory laparotomy.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous transhepatic insertion of a permanent endoprosthesis in obstructive lesions of the extrahepatic bile ducts

Hoevels

Ihse

1979

Gastrointest Radiol

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A Teflon endoprosthesis for permanent bile drainage was inserted in 13 patients following percutaneous transhepatic puncture and catheterization of the bile duct system. Twelve patients had extrahepatic cholestasis because of a malignant tumor, whereas one patient had chronic inflammation involving the hepatoduodenal ligament (secondary to Crohn's disease) with obstruction of the extrahepatic bile ducts. The drainage periods varied from 1 week to 8 months. The endoprosthesis was regarded as partially effective in seven patients whereas in six cases the drainage through the endoprosthesis was insufficient and external bile drainage through a percutaneous transhepatic catheter was necessary. Infection of the bile duct system during the drainage period with a percutaneous transhepatic catheter and/or bile duct endoprosthesis occurred in 10 patients. Spontaneous dislocation of the endoprosthesis occurred in varying degrees in five patients. One patient developed an intrahepatic aneurysm adjacent to the puncture tract and died because of liver insufficiency following therapeutic embolization of the aneurysm and most of the hepatic arteries by injection of gelfoam particles into the common hepatic artery. Patients in whom palliative treatment by insertion of a permanent bile duct endoprosthesis may be suitable were defined.

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“…Hingegen ist die Geschlechtsverteilung beim Gallengangscarcinom umgekehrt. Die durch sie induzierten Entziindungen und Ulcerationen sind als realisierende Faktoren der Carcinogenese zu betrachten [1, 3,5,6,12,16,17,23,31,34,35,37,41,44,46] Innerhalb von 20 Jahren wurden 300 Patienten wegen einem Carcinom an den ableitenden Gallenwegen operiert. Die Altersverteilung der Gallenwegscarcinome zeigt, dal3 diese in der Regel eine Erkrankung des h6heren Lebensalters darstellen.…”

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Therapie und Prognose bei 300 prim�ren extrahepatischen Gallenwegscarcinomen

Dittel

Kraft

Riese

et al. 1983

Langenbecks Arch Chiv

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A total of 300 patients (66% women, 34% men) had carcinoma of the bile ducts; 64% were located in the gallbladder and 36% in the bile ducts. In 77.3% the carcinomas had metastasized or were conglomerate tumors, while in 22.7% a curative resection was performed. In 35.3% a palliative operation or resection was indicated. An exploratory laparotomy was performed in 42%, but 75% of the patients died within 6 months. After 1 year 10.2% had survived. After curative resection 46 patients survived on the average over 17.6 months, while 12 patients survived an average of 5.1 years.

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Bypass operations for neoplastic biliary tract obstruction

Cited by 75 publications

References 1 publication

Etiological spectrum and treatment outcome of Obstructive jaundice at a University teaching Hospital in northwestern Tanzania: A diagnostic and therapeutic challenges

Etiological spectrum and treatment outcome of Obstructive jaundice at a University teaching Hospital in northwestern Tanzania: A diagnostic and therapeutic challenges

Percutaneous transhepatic insertion of a permanent endoprosthesis in obstructive lesions of the extrahepatic bile ducts

Therapie und Prognose bei 300 prim�ren extrahepatischen Gallenwegscarcinomen

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