Dg. Hutson et al., BALLOON DILATATION THROUGH THE SUBCUTANEOUSLY PLACED AFFERENT LIMB OFA HEPATICOJEJUNOSTOMY IN PATIENTS WITH RESECTED KLATSKIN TUMORS, The American surgeon, 61(6), 1995, pp. 518-520
It is generally conceded that palliation for proximal bile duct tumors
(Klatskin) is exceptional if obstruction and the resultant infections
can be prevented. Our experience with balloon dilatations thru the su
bcutaneously placed afferent limb of a choledocho or hepatico jejunost
omy in patients with benign strictures suggests that this approach wil
l be effective in patients with malignancies and thus provide long-ter
m control of the obstruction without the need for external tubes. This
is a report on one patient who, following a resected Klatskin tumor w
ith positive margins, was treated with transhepatic internal external
stents and was converted to a subcutaneous limb following numerous bou
ts of cholangitis. A schedule for repeat dilatations thru the jejunal
Limb was established. The patient has remained afebrile with a normal
bilirubin and a moderately elevated alkaline phosphatase. Recurrent tu
mors or postirradiation strictures in patients with resected Klatskin
tumors can be effectively controlled by repeated balloon dilatation wi
thout the need for external stents.