MALIGNANT BILIARY OBSTRUCTION - PRELIMINARY-RESULTS OF PALLIATIVE TREATMENT WITH HEPATICOGASTROSTOMY UNDER FLUOROSCOPIC, ENDOSCOPIC, AND LAPAROSCOPIC GUIDANCE

PURPOSE: To report a technique of peripheral biliary decompression by means of anastomosis of a bile duct in segment II of the liver to the lesser curvature of the stomach. MATERIALS AND METHODS: Seven patients with unresectable biliary neoplasm were treated. After transhepatic c atheterization of a segment II bile duct, the left lobe of the liver a nd the lesser curvature of the stomach were perforated under fluorosco pic and laparoscopic guidance. Anastomosis between the biliary tree an d the stomach was maintained with a gastrostomy tube placed across the tract. After 2 weeks, the tube was removed and patency of the tract w as preserved with a metallic stent. RESULTS: Three patients died, at 3 , 6, and 9 months, respectively, without reocclusion; the other four w ere alive at 5 months without jaundice. One patient had an episode of cholangitis, which was resolved with antibiotic therapy. CONCLUSION: T his method yields a good patency rate with few problems. Further inves tigation is required to evaluate long-term patency and the necessity o f laparoscopic guidance.