Laparoscopic biliary and enteric bypass

Chekan, Edward; Clark, Lisa; Wu, Justin J.; Pappas, Theodore N.; Eubanks, Steve

doi:10.1002/(sici)1098-2388(199906)16:4<313::aid-ssu6>3.0.co;2-d

Cited by 26 publications

(10 citation statements)

References 14 publications

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“…37 A number of publications have described laparoscopic procedures for the palliation of malignant distal common bile duct obstruction. [38][39][40][41] These have included cholecystojejunostomy and Roux-en-Y choledochojejunostomy. However, the case series are small, and no clinical trials have been published.…”

Section: Discussionmentioning

confidence: 99%

Biliary stenting versus bypass surgery for the palliation of malignant distal bile duct obstruction: A meta-analysis

2000

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The objective of this analysis is to compare endoscopic stenting with surgical bypass in patients with unresectable, malignant, distal common bile duct obstruction using the technique of meta-analysis. The inclusion criteria for the studies were randomized patient assignment, publication in the English language, 20 or more patients per group, all patients followed up until death, and follow-up and complications reported in an equivalent way for both treatment arms. Data extraction was performed independently by 2 of the authors. The number of treatment failures, serious complications, requirement for additional treatment sessions, and 30-day mortality were extracted. Three existing trials met the inclusion criteria, all of which compared surgery with the use of plastic stents. There were no studies identified that used metallic expandable stents. For the rate of treatment failure and serious complications, the odds ratios (ORs) of the 3 trials were heterogeneous, and no summary ORs were calculated. More treatment sessions were required after stent placement than after surgery, and a common OR was estimated to be 7.23 (95% confidence interval [CI], 3.73 to 13.98). Thirty-day mortality was not significantly different (OR = 0.522; 95% CI, 0.263 to 1.036). Although surgical bypass required fewer additional treatment sessions, existing data do not allow a definitive conclusion on which treatment is preferable. A larger randomized controlled trial using newer metallic stents and proper quality-of-life instruments is required.

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Section: Discussionmentioning

confidence: 99%

Biliary stenting versus bypass surgery for the palliation of malignant distal bile duct obstruction: A meta-analysis

2000

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“…Less experience is available for jejunal stenting, but this has been reported. Laparoscopic gastrojejunostomy can include biliary bypass if necessary 85 …”

Section: Resultsmentioning

confidence: 99%

“…Laparoscopic gastrojejunostomy can include biliary bypass if necessary. 85 Endoscopic, fluoroscopic or combination endofluoroscopic metal stent insertion can be performed on an outpatient basis. Stents may be covered to prevent tumour ingrowth and flared at the ends to discourage migration.…”

Section: Palliative Surgerymentioning

confidence: 99%

Adenocarcinoma of the small bowel

Hutchins

Hani

Kojodjojo

et al. 2001

ANZ Journal of Surgery

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Cancer of the small bowel is a rare entity but its incidence is rising. Historically, outcome is poor despite apparent curative resection. At present surgery remains the only treatment modality of proven benefit in the management of this disease. Recent data would suggest 5-year survival rates in the order of 40-50% at all sites of small bowel cancer. To improve upon this, earlier diagnosis with a high index of suspicion and multicentre adjuvant therapy trials are required.

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“…Laparoscopic choledochojejunostomy has been evaluated, yet it was found to be technically difficult, primarily due to the handling of minute and delicate structures in a two‐dimensional monitoring system, with loss of perception of visual depth 7,10. Also, suturing of the biliodigestive anastomosis seems especially intricate 9…”

Section: Discussionmentioning

confidence: 99%

“…Most surgeons prefer to perform a Roux‐en‐Y choledochojejunostomy . As an alternative to the open procedure, a laparoscopic setup has been tested . This has proven possible, yet technically challenging, and thus the open procedure is still opted for 7,9,10…”

Section: Introductionmentioning

confidence: 99%