Bypass procedure for bile duct cancer

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Abstract
In spite of the great advances made in diagnostic procedures and patient management, and the aggressive attitude adopted by most surgeons, a sizable portion of bile duct cancer remains unresectable and should be treated by palliative procedures. We reviewed 93 patients with bile duct cancer treated in our department during the 20‐year period from 1965 to 1984, and found that biliary enteric anastomosis offers the best palliation with acceptable mortality and complication rates and increases length of survival and improves quality of life. For proximal third bile duct cancer, the approach in the plane of the falciform ligament by Bismuth and Corlette and the anastomosis of the duct of the lateral inferior segment, segment III, or anterior inferior segment, segment V, to a Roux‐Y jejunal loop is recommended because of its sufficient size, accessibility, and distance from the tumor. For middle and distal thirds bile duct cancer, hepaticodochojejunostomy (Roux‐Y) is preferred by first transecting the common hepatic or common bile duct and anastomosing it to the Roux‐Y jejunal loop to delay encroachment by the distally located bile duct cancer.