INTRAHEPATIC SEGMENT-III CHOLANGIOJEJUNOSTOMY IN ADVANCED-CARCINOMA OF THE GALLBLADDER

The majority of patients with advanced carcinoma of the gallbladder ha ve irresectable disease and require palliation for jaundice, pruritus and cholangitis. Intrahepatic segment III cholangiojejunostomy has bee n described for palliation of high biliary obstruction in these patien ts. Forty-one patients with stage IV gallbladder cancer underwent intr ahepatic segment III cholangiojejunostomy. Subsequent jaundice, prurit us and cholangitis were documented; liver function tests and isotope h epatobiliary scans were performed. All patients had jaundice, 29 had p ruritus and 12 had cholangitis. Postoperative complications included a nastomotic leak in six patients and wound infection in six. Five patie nts died within 30 days of operation. Thirty-two patients were availab le for follow-up. The procedure failed to relieve jaundice, pruritus o r cholangitis in four patients; 18 were free of jaundice, pruritus and cholangitis until death or last follow-up, and ten had recurrent jaun dice or cholangitis. Isotope scanning was found to be useful to predic t success of the procedure. Intrahepatic segment III cholangiojejunost omy provided excellent palliation from jaundice, pruritus and cholangi tis with acceptable mortality and morbidity rates in patients with adv anced carcinoma of the gallbladder.