External bypass operation for biliary tract obstruction.

Abstract

To the Editor .—Biliary obstruction secondary to nonresectable malignancy or inflammatory and iatrogenic stricture of the biliary tract is a serious condition. Decompression is essential to relieve obstruction, to allay symptoms, and to prolong life. Many procedures for decompression of the biliary tract have been reported, including bypass operations, 1 percutaneous transhepatic drainage, 2,3 and internal prostheses. 4 I and my colleagues have been using an external biliary bypass that decompresses the biliary tree, bypasses the obstruction, and is easy to perform. At the time of laparotomy, a portion of the dilated biliary tract is exposed and opened proximal to the obstruction. A T-tube is inserted, with the long stem of the T-tube drawn to the exterior through a small stab wound. Similarly, the common duct, duodenum, or jejunum distal to the obstruction is selected and a T-tube is inserted. As with the proximal tube, the long vertical stem of