Palliative Treatment of the Pancreatic Carcinoma: What Surgical By-Pass?

Background The palliative treatment of the neoplastic obstructive jaundice foresees two possibilities: the position of endoscopic biliary stents or the surgical biliary by-pass. The digestive-biliary by-pass are differentiated in cholecystojejunostomy and hepatic-jejunostomy. Aim The aim of the study is to evaluate the results after the cholecystojejunostomy. Methods In the period from 1998 to June 2003, we have retrospectively evaluated 31 patients with jaundice from inoperable pancreatic neoplasia: 18 patients were treated with position of endoscopic stent; 13 patients underwent the palliative intervention of cholecystojejunostomy. The preoperative evaluation was made evaluating the following parameters: instrumental evaluation (US/CT) of the increase of the gallbladder volume; notice of the neoplastic lesion; intraoperatory evaluation: patency of the cystic duct; cholecystojejunal anastomosis on a Roux en Y jejunal loop (by means of stapler or manual). Results We have evaluated: operative time length (mean: 60 minutes), reduction of the jaundice in all patients; specific morbidity: no anastomotic dehiscences, mean patient mobilization equal to 2 days, mean resumption of the alimentation in the fourth day in, mean hospital dismissal in the seventh day, one bronchopneumonic infiltrate. The distant results confirm the reduction of the jaundice at a follow-up of 6 and 8 months. Conclusions The cholecystojejunostomy was safe, because of the very low postoperative morbidity and effective, to control the jaundice even after distant time from the intervention, in the palliative treatment of the pancreatic carcinoma.