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Endo-laparoscopic approach in the management of obstructive jaundice and malignant gastric outflow obstruction.
Hepatogastroenterology. 2005 Jan-Feb; 52(61):128-34.H

Abstract

BACKGROUND/AIMS

Only a minority of patients with tumor at the pancreaticoduodenal junction is suitable for resection, palliation is however often required relieving the obstructive jaundice and gastric outflow obstruction (GOO). This study evaluates endo-laparoscopic approach as a palliative treatment of obstructive jaundice and malignant gastric outflow obstruction.

METHODOLOGY

A retrospective review of a prospectively maintained database. During the period from 1992-2002, patients with diagnosis of unresectable tumor at the pancreaticoduodenal junction were evaluated. If the tumor was confirmed to be unresectable, patients would be offered either open double bypass or laparoscopic gastrojejunostomy (LGJ) +/- endoscopic or percutaneous transhepatic stenting for any obstructive jaundice, the choice of approach would depend on whether the endoscopic access was still maintained.

RESULTS

Out of 942 patients with tumors around the pancreaticoduodenal junction during the study period from 1992-2002, there were 34 patients (13 male & 21 female) with median age 69 years (range, 48-87) selected for LGJ. Of these 34 patients, 3 of them underwent endoscopic biliary stenting whereas 16 jaundice patients were palliated by transhepatic biliary drainage. When the results were compared to the 35 open double bypass (roux-en-Y choledochojejunostomy and gastrojejunostomy) during the same study period, the median operation time was significantly shorter (80 vs. 135 minutes; P=0.0001) and median intraoperative bleeding was significantly less in the endo-laparoscopic group (0 vs. 100mL; P=0.0001). Two patients in the endo-laparoscopic group were converted to open because of tumor infiltration of the small bowel mesentery causing difficulty in construction of gastrojejunostomy. Although the overall complication rate (13 vs. 17; P=0.387) and incidence of delayed gastric emptying (7 vs. 7, P=0.952) were similar in both groups, the incidence of wound infection was remarkably less common in the endo-laparoscopic group (0 vs. 6, P=0.012). The 15 postoperative complications (13 patients) in the endo-laparoscopic group (38.2%) included prolonged gastric stasis (7), biliary sepsis (2), chest infection (2), myocardial ischemia (2), gastrointestinal bleeding (1) and extensive ischemic stroke (1). Median time to resume diet was statistically shorter in endo-laparoscopic group (5 vs. 7 days, P=0.009) however the hospital stay was similar in both groups (11.5 vs. 14 days, P=0.238). The hospital mortality rate was again comparable between the two groups (6 vs. 5, P=0.703). The short median survival in the endolaparoscopic group (3 vs. 7 months; P=0.0001) might just be a reflection of selection bias.

CONCLUSIONS

With the advent of laparoscopic and endoscopic surgery, palliation of both gastric outflow obstruction and obstructive jaundice can also be accomplished using the endo-laparoscopic approach. In comparing to the open double bypass, operation time, intraoperative blood loss and incidence of wound infection are significantly less and patients can have early resumption of diet. However, the results can be improved further with a better patient selection and perioperative optimization.

Authors+Show Affiliations

Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Hong Kong. cntang@netvigator.comNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

15783012

Citation

Tang, C N., et al. "Endo-laparoscopic Approach in the Management of Obstructive Jaundice and Malignant Gastric Outflow Obstruction." Hepato-gastroenterology, vol. 52, no. 61, 2005, pp. 128-34.
Tang CN, Siu WT, Ha JP, et al. Endo-laparoscopic approach in the management of obstructive jaundice and malignant gastric outflow obstruction. Hepatogastroenterology. 2005;52(61):128-34.
Tang, C. N., Siu, W. T., Ha, J. P., & Li, M. K. (2005). Endo-laparoscopic approach in the management of obstructive jaundice and malignant gastric outflow obstruction. Hepato-gastroenterology, 52(61), 128-34.
Tang CN, et al. Endo-laparoscopic Approach in the Management of Obstructive Jaundice and Malignant Gastric Outflow Obstruction. Hepatogastroenterology. 2005 Jan-Feb;52(61):128-34. PubMed PMID: 15783012.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Endo-laparoscopic approach in the management of obstructive jaundice and malignant gastric outflow obstruction. AU - Tang,C N, AU - Siu,W T, AU - Ha,J P Y, AU - Li,M K W, PY - 2005/3/24/pubmed PY - 2005/7/13/medline PY - 2005/3/24/entrez SP - 128 EP - 34 JF - Hepato-gastroenterology JO - Hepatogastroenterology VL - 52 IS - 61 N2 - BACKGROUND/AIMS: Only a minority of patients with tumor at the pancreaticoduodenal junction is suitable for resection, palliation is however often required relieving the obstructive jaundice and gastric outflow obstruction (GOO). This study evaluates endo-laparoscopic approach as a palliative treatment of obstructive jaundice and malignant gastric outflow obstruction. METHODOLOGY: A retrospective review of a prospectively maintained database. During the period from 1992-2002, patients with diagnosis of unresectable tumor at the pancreaticoduodenal junction were evaluated. If the tumor was confirmed to be unresectable, patients would be offered either open double bypass or laparoscopic gastrojejunostomy (LGJ) +/- endoscopic or percutaneous transhepatic stenting for any obstructive jaundice, the choice of approach would depend on whether the endoscopic access was still maintained. RESULTS: Out of 942 patients with tumors around the pancreaticoduodenal junction during the study period from 1992-2002, there were 34 patients (13 male & 21 female) with median age 69 years (range, 48-87) selected for LGJ. Of these 34 patients, 3 of them underwent endoscopic biliary stenting whereas 16 jaundice patients were palliated by transhepatic biliary drainage. When the results were compared to the 35 open double bypass (roux-en-Y choledochojejunostomy and gastrojejunostomy) during the same study period, the median operation time was significantly shorter (80 vs. 135 minutes; P=0.0001) and median intraoperative bleeding was significantly less in the endo-laparoscopic group (0 vs. 100mL; P=0.0001). Two patients in the endo-laparoscopic group were converted to open because of tumor infiltration of the small bowel mesentery causing difficulty in construction of gastrojejunostomy. Although the overall complication rate (13 vs. 17; P=0.387) and incidence of delayed gastric emptying (7 vs. 7, P=0.952) were similar in both groups, the incidence of wound infection was remarkably less common in the endo-laparoscopic group (0 vs. 6, P=0.012). The 15 postoperative complications (13 patients) in the endo-laparoscopic group (38.2%) included prolonged gastric stasis (7), biliary sepsis (2), chest infection (2), myocardial ischemia (2), gastrointestinal bleeding (1) and extensive ischemic stroke (1). Median time to resume diet was statistically shorter in endo-laparoscopic group (5 vs. 7 days, P=0.009) however the hospital stay was similar in both groups (11.5 vs. 14 days, P=0.238). The hospital mortality rate was again comparable between the two groups (6 vs. 5, P=0.703). The short median survival in the endolaparoscopic group (3 vs. 7 months; P=0.0001) might just be a reflection of selection bias. CONCLUSIONS: With the advent of laparoscopic and endoscopic surgery, palliation of both gastric outflow obstruction and obstructive jaundice can also be accomplished using the endo-laparoscopic approach. In comparing to the open double bypass, operation time, intraoperative blood loss and incidence of wound infection are significantly less and patients can have early resumption of diet. However, the results can be improved further with a better patient selection and perioperative optimization. SN - 0172-6390 UR - https://www.unboundmedicine.com/medline/citation/15783012/Endo_laparoscopic_approach_in_the_management_of_obstructive_jaundice_and_malignant_gastric_outflow_obstruction_ L2 - https://medlineplus.gov/palliativecare.html DB - PRIME DP - Unbound Medicine ER -