SURGICAL BILIARY BYPASS FOR BENIGN AND MALIGNANT EXTRAHEPATIC BILIARY-TRACT DISEASE

Background The optimal management of patients with benign and malignan t disease affecting the extrahepatic biliary tract remains unresolved. A retrospective study was undertaken of all surgical biliary bypass p rocedures performed in one hepatobiliary unit. Methods A total of 121 patients treated in a 9-year period and comprising 60 patients with be nign disease and 61 with malignant disease were reviewed. Results Ther e was no significant difference in 30-day mortality rate between patie nts with benign and malignant disease (2 versus 8 per cent respectivel y, P = 0.22). There was no significant difference between surgery for benign and malignant disease in early morbidity rate (13 versus 21 per cent respectively, P = 0.36) or late morbidity rate (20 versus 25 per cent, P = 0.70). The median postoperative stay in both groups of pati ents was 10 days. The median survival of all patients with malignant d isease was 7 months, being significantly more favourable for those wit h cholangiocarcinoma (18 months) than for those with pancreatic carcin oma (6.5 months) (P < 0.01). Conclusion Biliary bypass procedures can be undertaken with acceptable rates of morbidity and mortality, and th erefore should be considered in all patients with malignant disease of the extrahepatic biliary tract. If there is evidence of advanced mali gnancy, or if the patient is unfit for surgical intervention, non-oper ative procedures are a suitable alternative.