ABSTRACT
PURPOSE: To assess the safety and efficacy of percutaneous retrograde transjejunal cholangiography and biliary intervention for benign and malignant disease. MATERIALS AND METHODS: The clinical and radiographic records of 43 patients (31 with benign and 12 with malignant disease) who had undergone percutaneous retrograde transjejunal biliary intervention over a 10-year period at a single institution were reviewed. One hundred eighty-one procedures were performed via a fixed Roux-en-Y loop and 15 via an unfixed loop. RESULTS: Percutaneous retrograde transjejunal cholangiography was attempted on 196 occasions (143 for benign and 53 for malignant disease). Primary successful access was obtained in 181 (92.3%). Adjunctive percutaneous transhepatic cholangiography improved successful access in an additional seven procedures, to 188 (95.9%). Interventions included stricture dilation, stone extraction, stent insertion, and brachytherapy. The mean number of biliary interventions and the mean interval between them were 3.1 interventions and 5.9 months in the benign group and 3.6 interventions and 3.8 months in the malignant group. The complication rate was 4.1%, with no deaths or episodes of biliary sepsis. CONCLUSION: Percutaneous transjejunal biliary access allows repeated interventions over many years with a low morbidity. Routine superficial fixation of Roux-en-Y loops is recommended for all biliary-enteric anastomoses to allow use of this safe and effective approach for any subsequent biliary intervention.
Subject(s)
Anastomosis, Roux-en-Y , Bile Duct Diseases/therapy , Cholangiography/methods , Radiography, Interventional/methods , Bile Duct Diseases/diagnostic imaging , Biliary Tract Neoplasms/diagnostic imaging , Biliary Tract Neoplasms/therapy , Brachytherapy , Cholangiography/statistics & numerical data , Choledochostomy , Cholelithiasis/diagnostic imaging , Cholelithiasis/therapy , Dilatation , Female , Hepatic Duct, Common/surgery , Humans , Jejunum/surgery , Male , Middle Aged , Radiography, Interventional/statistics & numerical data , Retrospective Studies , Stents , Time FactorsABSTRACT
Debate continues as to the appropriateness of the Whipple procedure. This retrospective review confirms that it is a worthwhile operation when done by experienced surgeons on suitable patients. Meticulous intra-operative technique must be followed by judicious postoperative care. In this series of 27 Whipple operations major morbidity occurred in 26% of cases. Leakage from the pancreatic anastomosis was infrequent (11%). Various anastomotic techniques were used, depending on the findings at operation. There were no peri-operative deaths and five-year actuarial survival is 63%.
Subject(s)
Pancreatectomy , Pancreatic Neoplasms/surgery , Adult , Aged , Female , Humans , Male , Middle Aged , Pancreatic Neoplasms/mortality , Pancreatic Neoplasms/pathology , Postoperative Complications , Retrospective StudiesABSTRACT
Carcinoma of the papilla of Vater was diagnosed in 18 patients during the period 1970 to 1980. In ten patients, surgical treatment was facilitated by a preoperative diagnosis based on duodenal endoscopy, biopsy, cytology and retrograde cholangiopancreatography. Of 16 patients with apparently localised disease at laparotomy, nine had pancreatoduodenectomy (Whipple's operation), three had local resection and four had biliary bypass. Six of nine patients treated by pancreatoduodenectomy are surviving for periods ranging from one to ten years, mean four years, whereas the four patients treated by biliary bypass survived for 0 to 18 months. Tumour recurred in the region of the papilla in two of three patients treated by local resection. Carcinoma of the papilla of Vater is usually localised at the time of diagnosis and prolonged survival can be achieved by pancreatoduodenectomy.
