Management of Malignant Obstructive Jaundice: Defining the Relevance of Various Palliative Surgical Options in Resource-Challenged Settings: A Review Article.

Abstract

Malignant obstructive jaundice (MOJ) constitutes an important surgical problem with high morbidity and mortality worldwide. Presentation is usually delayed with a majority of patients benefitting only from palliative treatment. Surgeons practicing in developing countries face herculean task in managing MOJ due to lack of minimally invasive endoscopic procedures. Palliative surgical procedures are associated with high morbidity and sometimes mortality. Abdominal pain, generalized pruritus, and gastric outlet obstruction are some of the symptoms of MOJ requiring palliation. Successful surgical palliation may improve the overall quality of life in patients with MOJ considered fit for surgery. Bypass procedures and regional nerve blocks constitute the most effective surgical palliation available to surgeons practicing in resource-limited settings. This review article discusses the indications, the role, and types of surgical bypass procedures in the management of MOJ in contemporary surgical practice. This is important for surgeons in countries where expertise and resources for the less morbid endoscopic and radiologic approaches are not available. Relevant articles up to January 2021 published in PubMed, Google Scholar, and Hinari on the surgical management of obstructive jaundice were reviewed for inclusion. We also reviewed some modern surgical textbook topics on obstructive jaundice.