END-TO-END DUODENOJEJUNAL BYPASS FOR UNRESECTABLE PERIAMPULLARY CARCINOMA

Palliative operation plays an important part in the treatment of peria mpullary carcinoma. However, gastric bypass such as the widely practic ed side-to-side gastrojejunostomy frequently fails to provide adequate drainage. Here we attempted to fashion an end-to-end duodenojejunosto my in the hope of establishing physiological continuity of the stomach and duodenum. Biliary bypass with side-to-side choledochojejunostomy is performed simultaneously. Eight patients underwent this surgery. In seven of these, radical resection proved to be impossible, and in one the duodeno-biliary decompression was attempted before the radical op eration. Early results were satisfactory in all patients. They began t o eat liquid meals within a week, and were discharged uneventfully wit hin the third postoperative week, when they were able to eat a regular diet. No ulcer developed in any of the patients. Plasma gastrin level s following a test meal was significantly lower after the operation, b ut plasma CCK-N and GIP levels showed no statistical difference prior to and after surgery, This duodenojejunal bypass is recommended as a m eans of improving the quality of the remaining life of the patients.