ABSTRACT
In cases with irresectable periampullary carcinoma of the pancreas whenever open surgery is deemed necessary for palliation, biliary - enteric bypass is a routine but adding prophylactic gastrojejunostomy in the absence of duodenal obstruction is a matter of controversy despite a lot of research. This study is a prospective comparative study that includes 60 patients diagnosed either pre-or intra-operatively as irresectable peniampullary carcinoma of the pancreas without evidence of impending duodenal obstruction Patients included in the study are divided into three groups. Group I include 26 patients diagnosed preoperatively and palliated by endoscopic biliary stenting alone. Group II include 17 patients where open surgery is deemed necessary for palliation, either due to failure of endoscopic biliary stenting or intraoperative diagnosis of irresectability, palliation is done by biliary diversion only [Roux- en-Y choledochojejunostomy]. Group III include 17 patients with the same criteria as group II but palliation is done by biliary diversion together with prophylactic gastrojejunostomy. Follow up is that done tilt development of duodenal obstruction or cancer related death. The result is that there is no increase in mortality or morbidity by adding prophylactic gastrojejunostomy to the initial operation .Late duodenal obstruction occurred in 17.6-19% when no gastrojejunostomy was done with high mortality 20-33% after late intervention. We recommend adding prophylactic gastrojejunostomy as a routine in the palliation of irresectable periampullary carcinoma whenever open surgery is needed even in absence of duodenal obstruction