Biliary and duodenal bypass for carcinoma of the head of the pancreas

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Abstract
A review was undertaken of 66 patients having palliative bypass surgery for carcinoma of the head of the pancreas. A second laparotomy for relief of duodenal obstruction was necessary in six of 29 (20%) of the patients who did not have gastroenterostomy performed initially, but late gastric outlet obstruction occurred only once in 37 patients having an initial gastroenterostomy (P < 0.05). Cholecystojejunostomy failed to provide permanent biliary bypass in 14 of 53 (26%) patients, compared to successful drainage in all 13 patients having anastomosis of the common hepatic duct to the jejunum (P < 0.05). In seven patients cholecystojejunostomy was performed when the cystic duct was already obstructed by tumour. Therefore prophylactic gastrojejunostomy is recommended as a routine. The gallbladder should only be used for biliary bypass when appropriate contrast x‐rays have demonstrated the patency of the cystic duct.