LAPAROSCOPIC TREATMENT OF BILIARY AND GASTRIC OUTLET OBSTRUCTION

To avoid laparotomy in patients with biliary or gastric outlet obstruc tion in inoperable carcinoma of the pancreas, we evaluated the feasibi lity of double-bypass operation in 20 pigs. In model A (n = 10), bilia ry bypass was a Roux-en-Y loop for cholecystojejunostomy after choledo chal clip occlusion. In model B (n = 10) an additional Roux-en-Y loop was attached to the stomach after transection of the duodenum. Model A showed functioning biliary bypass with patent and leak-free anastomos es at necropsy on day 28. In model B, four pigs were sacrificed earlie r, but nine had normal functioning double bypass (two intussusceptions of the ileum, one bleeding ulcer at the gastroenterostomy, one necrot ic Roux-en-Y-loop). Based on the presented bypass function, we are enc ouraged to perform laparoscopic biliary and gastroenteral bypass in hu mans to treat malignant jaundice and gastric outlet obstruction.