LEFT HEPATICOGASTROSTOMY FOR BILIARY OBSTRUCTION - LONG-TERM RESULTS

PURPOSE: To evaluate the long-term results of peripheral biliary diver sion by means of anastomoses of the left lobe of the liver to the stom ach. MATERIALS AND METHODS: Transhepatic perforation of the left lobe of the liver into the lesser curvature of the stomach was performed in 35 patients with a presumed diagnosis of malignant obstructive jaundi ce. Jaundice was found to be caused by a malignant stricture in 32 pat ients and a benign stricture in three. Perforation was performed under fluoroscopic, endoscopic, and laparoscopic guidance in 33 patients an d without laparoscopy in the other two. The hepaticogastric anastomosi s was secured with a gastrostomy tube; patency of the tract was mainta ined with placement of a metallic stent. Kaplan-Meier analysis was use d to evaluate survival, anastomosis patency rate, and jaundice recurre nce. RESULTS: Technical success was achieved in all patients. Two (6%) patients had anastomotic obstruction. The actuarial survival rate was 91%, 80%, 59%, and 26% at 1, 3, 6, and 12 months. The mean patency wa s 234 days +/- 252. The jaundice-free rate among surviving patients wa s 100%, 96%, 93%, and 80% at 1,3, 6, and 12 months. The reintervention rate was 14%. Late cholangitis occurred in seven (20%) patients. CONC LUSION: This peripheral diversion procedure appears to be safe and sho ws good long-term patency.