THE CURRENT ROLE OF U-TUBES FOR BENIGN AND MALIGNANT BILIARY OBSTRUCTION

Objective. The recent experience with U tubes at Rush-Presbyterian-St. Lukes Medical Center was reviewed in order to assess their current ro le in hepatobiliary surgery. Summary Background Data. Transhepatic int ubation by a variety of methods has been used routinely for biliary de compression and inhibition of anastomotic stricture since the 1960s. U tubes were popularized in the early 1970s. However, little has been w ritten about their use and efficacy in recent years. Because of the ap parent benefits associated with the use of U tubes versus other stenti ng techniques, the authors performed this study. Methods. The hospital and office charts of all patients who had U tubes placed between 1980 and 1992 were reviewed retrospectively. Between 1980 and 1992, U tube s were placed intraoperatively in 54 patients for biliary decompressio n and/or stenting. Twelve patients were operated on for benign causes of obstruction. Forty-two patients with malignant tumors underwent sur gery for U tube placement in conjunction with or without tumor resecti on and anastomotic bypass. Results. There was a 0% operative mortality rate in the benign group. In six patients, the U tube played a major role in the long-term management of their disease processes. None of t hese patients has had restricture since removal of the tube. In the ma lignant group, the 30-day operative mortality rate was 12%. After 3 mo nths, marked clinical improvement and complete biliary decompression w ere achieved, with mean bilirubin levels dropping from 14.0 mg/dL to 1 .3 mg/dL. No patients in the malignant group required reoperation for recurrent biliary obstruction after U tube placement. Conclusions. The use of U tubes is advocated for biliary decompression and/or anastomo tic stenting in patients with benign stricture or resectable malignanc y and in patients with nonresectable, malignant biliary obstruction fo r adequate palliation of intractable jaundice.