Simultaneous laparoscopic biliary and retrocolic gastric bypass in patients with unresectable carcinoma of the pancreas

Background: A substantial number of patients with unresectable pancreatic c ancer eventually develop biliary or gastric outlet obstruction. In some cas es, they present initially with both complications. These conditions contri bute markedly to their discomfort and certainly justify palliative interven tion. The purpose of this study was to examine the feasibility and safety o f simultaneous laparoscopic biliary and gastric bypass in patients with unr esectable carcinoma of the pancreas. Methods: Between August 1995 and July 1998, simultaneous laparoscopic bilia ry and retrocolic gastric bypass was performed successfully in 12 consecuti ve patients with unresectable carcinoma of the pancreas. There were eight m en and four women. Their median age was 72 years (range, 50-82). In all pat ients, the indications for gastrointestinal bypass were gastric outlet obst ruction and obstructive jaundice. The following parameters were evaluated f or each patient: procedure-related morbidity and mortality, operative time, length of hospital stay, overall survival, and ability to sustain oral nut rition during the survival period. Results: All procedures were completed laparoscopically. The mean operative time was 89 +/- 29.56 min. There were no intraoperative complications. Pos toperative morbidity consisted of wound infection in two patients and pneum onia in one patient. One patient died of multiorgan failure on postoperativ e day 2. The mean hospital stay was 6.4 +/- 1.5 days (range, 5-17). The mea n survival time until death from underlying disease was 85 +/- 32.46 days ( range, 31-260). None of the patients had recurrent jaundice, and all of the m were able to maintain oral nutrition. Conclusion: Simultaneous laparoscopic biliary and retrocolic gastric bypass is a safe and effective technique for the treatment of biliary and gastrod uodenal obstruction in patients with unresectable pancreatic cancer.