Relief Of Obstructive Jaundice Research Articles

EVALUATION OF INDOCYANINE GREEN RETENTION AND AMINOPYRINE BREATH TESTS IN PATIENTS WITH MALIGNANT BILIARY OBSTRUCTION

Impaired hepatic function is a major contributory factor to the high incidence of postoperative morbidity and mortality in patients with malignant biliary obstruction. Dynamic hepatic function tests such as indocyanine green (ICG) retention and aminopyrine breath tests were evaluated in such patients to define whether they were clinically useful for prediction of postoperative morbidity and mortality. Forty-four patients with malignant biliary obstruction undergoing surgery for relief of obstructive jaundice were recruited into the study. Indocyanine green retention and aminopyrine breath tests were carried out in all patients pre-operatively and repeated in 36 patients postoperatively. The ICG retention was abnormal in all patients before surgery and there was significant improvement 2 weeks after surgery (32.8 +/- 2.5% vs 18.3 +/- 2.8%, P = 0.001). The change in ICG retention levels correlated with the serum bilirubin levels but the pre-operative ICG retention value could not predict postoperative morbidity and mortality. The aminopyrine breath test was abnormal in all but one patient. It correlated with pre-operative prothrombin time of the patients before surgery but it did not improve significantly after surgery and was not predictive of postoperative outcome. It is concluded that both ICG retention and aminopyrine breath tests have limited clinical value in the pre-operative evaluation of patients with malignant biliary obstruction.

Growth failure and decreased levels of insulin-like growth factor I in obstructive jaundice are reversed by bile diversion

Insulin-like growth factor I (IGF-I) is one of the principal stimuli of linear growth. Growth failure in children with chronic cholestatic jaundice may be related to decreased hepatic synthesis of IGF-I. It was hypothesized that (1) biliary obstruction would lead to growth retardation and decreased circulating IGF-I levels; and (2) surgical drainage of the obstructed biliary system would reverse these effects. To test this hypothesis, the following study of male Sprague-Dawley rats (135 g; 10 animals per group) was performed. Group I underwent common bile duct ligation (CDL); group II underwent choledochoduodenostomy 2 weeks following CDL; group III were sham-operated and pair-fed with CDL rats; and group IV were sham-operated and fed ad libitum. Daily food intake and weekly body weight were recorded. Statistical analysis was by repeated-measures analysis of variance and individual comparisons were evaluated by Student's t test. Biliary obstruction results in decreased food intake, rate of weight gain, and IGF-I levels. A significant reduction in IGF-I levels was also noted in the pair-fed sham-operated rats (group III). Relief of obstructive jaundice by surgical drainage results in a reversal of these changes. It is concluded that the growth failure and decreased IGF-I levels associated with obstructive jaundice can be reversed by surgical drainage of the obstructed biliary system and, in part, are due to inadequate nutrition.

Organ Failure before and after Relief of Obstructive Jaundice

Organ Failure before and after Relief of Obstructive Jaundice

Outcome of surgery for obstructive jaundice is not associated with reduced levels of plasma fibronectin.

Reduced levels of plasma fibronectin have been implicated in the septicaemia and/or endotoxaemia that can accompany trauma or burns. Patients undergoing surgery for the relief of obstructive jaundice are also at risk of developing endotoxaemia or septicaemia. In this study, levels of plasma fibronectin were measured by immunoassay and bioassay in 16 such patients. No patient had a significantly reduced level of plasma fibronectin. Even in the case of patients developing a fatal septicaemia and general system failure there was no significant decrease in circulating fibronectin. It is concluded that measurement of plasma fibronectin is of no prognostic value and similarly infusion of fibronectin-rich cryoprecipitate would be of no therapeutic benefit.

Percutaneous transhepatic internal drainage using polyurethane double-pigtail endoprostheses

Relief of obstructive jaundice by the percutaneous transhepatic insertion of an endoprosthesis is now a well recognised and common radiological procedure. We report the successful insertion of polyurethane double-pigtail stents (made for transpapillary endoscopic insertion) by the percutaneous transhepatic route in five patients. Our experience indicates that these stents are as effective in relieving jaundice as, and less traumatic and easier to insert than, the larger varieties in common use.

The management of pancreatic carcinoma: a review of 173 cases.

Pancreatic carcinoma is an increasingly common malignancy, cure of which is rarely feasible. Ideal management involves the safe and effective palliation of symptoms once the diagnosis has been established beyond reasonable doubt and the unlikely possibility of cure by radical surgery ruled out. In this retrospective study of 173 patients, management fell short of the ideal. Histological confirmation of the diagnosis was obtained in only 42% of patients, and there was a 16% reoperation rate because of the failure of an initial palliative procedure to relieve actual or potential biliary or gastric outlet obstruction. Still more patients developed recurrent obstructive jaundice or duodenal obstruction but did not undergo further surgery. To achieve optimal palliation, it is recommended that a gastroenterostomy be performed whenever a palliative operation is undertaken for the relief of obstructive jaundice, and that biliary drainage be accomplished by anastomosis of bowel to the common hepatic duct rather than the gall-bladder whenever possible, to minimize the risk of recurrent obstruction. It is further recommended that an attempt be made to obtain a tissue diagnosis in every case, since other methods of diagnosis are unreliable.

The objectives of palliative surgery in pancreas cancer: a retrospective study of 73 cases.

In 73 cases of pancreas cancer, histological diagnosis was not obtained in 43 (59%). Relief of obstructive jaundice was not satisfactorilly achieved in 14 of 39 patients at risk (36%), while gastric outflow obstruction developed subsequent to surgery in eight of 31 patients at risk (26%). Fine needle aspiration cytology is advocated to improve the rate of positive peroperative tissue diagnosis. To relieve bile duct obstruction, cholecystojejunostomy is advocated only in patients with pancreas cancer who have a very short life expectancy, and only when the cystic duct is patent. Choledochojejunostomy and gastrojejunostomy "double bypass" is advocated for cancers which are macroscopically localized to the pancreatic area. The selective use of this double bypass will improve surgical palliation and minimize reoperations in cancer of the pancreas.

Percutaneous transhepatic insertion of a permanent prosthesis in the biliary tree. A new nonsurgical method for the relief of obstructive jaundice

Percutaneous transhepatic insertion of a permanent prosthesis in the biliary tree. A new nonsurgical method for the relief of obstructive jaundice