A comparison of choledochoenteric bypass and cholecystoenteric bypass in patients with biliary obstruction due to pancreatic cancer

Abstract

Debate concerning the superiority of cholecystoenteric bypass (CCEB) vs. choledochoenteric bypass (CDEB) in patients with pancreatic cancer and biliary obstruction prompted this review. Thirty-six patients with biliary duct obstruction due to pancreatic cancer underwent 37 operations for biliary decompression between 1976 and 1986: 22 CCEB, 15 CDEB. Age, sex, race, preoperative health, and preoperative symptoms and signs were similar for both groups. Seven CDEB patients had previous cholecystectomy (n = 5) and failed CCEB (n = 2). Twenty CCEB patients and 13 CDEB patients had elevated preoperative total bilirubin with an average abnormal bilirubin of 15.3 mg per cent and 12.0 mg per cent, respectively. Perioperative significant morbidity/mortality was seen in 59.1 per cent and 22.7 per cent, respectively, in CCEB and 53.3 per cent and 6.7 per cent in CDEB. Twenty (90.9%) CCEB patients and 15 (100%) CDEB eventually succumbed to either their operation or pancreatic cancer: average survival was 7.5 months (range, 2-41 months) and 10.4 months (range, 2-30 months), respectively. Two CCEB patients were alive at 15 and 41 months. Eleven out of 22 CCEB patients (50%) experienced short term (within 2 months of surgery) absence of jaundice, icterus, pruritus, and biliary tract disease symptoms or signs, and six out of 12 experienced long term (more than 3 months after surgery) absence of these problems; with CDEB, 14 patients out of 15 (93%) experienced short term and 10 out of 12 patients (83%) experienced long term absence of these problems. Cholecystoenteric bypass is a significantly morbid procedure and yet does not reliably palliate biliary obstruction due to pancreatic cancer; it is not preferred.