Malignant obstructive jaundice: rational method of surgical treatment.

Abstract

Background: Aim of the study is to choose rational method of biliary decompression in patients with malignant obstruction. 260 patients had biliary decompression for the 6 year period Methods: We focused on the anatomical level of biliary tract occlusion. Obstruction at the level of the common bile duct(CBD) was detected in 78.8% cases , common hepatic duct(CHD) with untouched confluence in 8,3% , confluence and above on lobal and segmental level of occlusion in 12,9 % Results: Cholecystostomy (CS) was performed in 24.2% cases, Percutaneous biliary drainage (PBD) in - 13.2%, Endoscopic stenting (ES) in - 47.6%, In 14% of cases we had to combine the two different methods of draining jaundice because of the inefficiency one of them. ES was successful in 91.3% cases with an occlusion at the level of CBD, in 72.0% at the level of the CHD In cases with occlusion above confluence ES was not applied. PBD was successfully in 87.5% cases with obstruction at the level of the CBD, at the level of CHD - 90%, at the level of lobal and segmental hepatic ducts - 88.2%. CS was effective in 77.9%, in cases with obstruction below the mouth of the cystic duct.Complications occurred in 13% of cases. After ES leading complication was cholangitis. The main complications after PBD and CS was bile leakage into the peritoneal or pleural cavity. Conclusion: ES has priority in cases with an occlusion level of the CBD and CHD with untouched confluence, PHD in cases with occlusion level of lobal and segmental ducts.