Abstract
This study reports the indications and outcome of various biliary bypass surgical procedures from a single centre over a period of 10 years. This is a prospective observational study conducted over a period of 10 years (January 2001-december 2010). A total of 1500 patients were included, who underwent pancreatico-biliary surgery due to common bile duct (CBD) stones, congenital anomalies of biliary tree, unoperable pancreatico-biliary malignancies, CBD strictures and cases who developed iatrogenic biliary injuries during cholecystectomy (both open & laproscopic) during this period of time. The patients who required biliary bypass surgery were further analysed for indications and outcome. Out of 1500 patients 83(5.53%) required biliary bypass surgical procedures. The CBD stones were observed as the most common indication (25.3%), followed by CBD injuries after open(10.84%) or laproscopic-cholecystectomy (14.46%), carcinoma head of pancreas (12.05%) and CBD obstruction(14.46%) either due to CBD strictures or unknown distal obstruction. Roux-en-Y-hepatico-jejunostomy (26.51%) was the most frequently performed procedure, followed by choledochoduodenostomy and Roux-en-Y choledocho-jejunostomy (i.e. 25.3% and 12.05% respectively). Roux-en-Y biliary bypass procedure was observed to be associated with better outcome in terms of rate of complications as well duration of hospital stay. Biliary bypass surgical procedures are the better options to restore the continuity of biliary system in patients with iatrogenic biliary tree injuries and un-operable pancreatico-biliary malignancy. Roux-en-Y biliary bypass procedure is safe and problem solving method in these cases.
Highlights
Biliary bypass surgery can be performed to reroute the biliary flow in patients with benign and malignant extrahepatic biliary tract disorders including biliary tree injuries, obstruction and congenital anomalies
There are various bilioenteric bypass procedures to deal these problems depending upon the pancreatico biliary pathology
The diagnosed patients with primary biliary disease or secondary to biliary surgery were operated for planned bypass surgical procedures. Those patients of common bile duct (CBD) stones having multiple stones, or CBD dilatation >2cm in size or having doubtful distal patency were considered for bypass procedures
Summary
Biliary bypass surgery can be performed to reroute the biliary flow in patients with benign and malignant extrahepatic biliary tract disorders including biliary tree injuries, obstruction and congenital anomalies. Pak J Med Sci 2013 Vol 29 No 3 www.pjms.com.pk 799 advanced digestive cancer.[2] Surgical bypass is considered as a treatment of choice for benign biliary diseases whereas a palliation for advanced biliary malignancies.[3]. Non-operative techniques are considered as first line of therapy for malignant biliary obstruction.[4,5] in developing countries palliative surgery is the only option available, because sophisticated equipments and expertise are limited to very few centeres.[6] The different biliary bypass surgical procedures have been advocated but bilio-enteric anastomosis in the form of Rouxen-Y Hepaticojejunostomy or choledochojejunostomy are considered as procedures of choice.[2,7,8] The laparoscopic biliary bypass surgical procedures are routinely performed in well developed centres but in this study all cases were operated by open surgical methods
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