Palliative laparoscopic Roux-en-Y choledochojejunostomy as a feasible treatment option for malignant distal biliary obstruction

Abstract

Purposes: The advantages of surgical bypass for patients with distal biliary obstruction caused by advanced periampullary cancer include a low risk of recurrent biliary obstruction; however, the highly invasive nature of the operation limits its use. Herein, we present the clinical findings of patients who underwent laparoscopic Roux-en-Y choledochojejunostomy (LRYCJ) compared with those who underwent endoscopic stent insertion.

Methods: We reviewed, retrospectively, the palliative care outcomes for malignant bile duct obstruction according to the type of intervention: LRYCJ vs. endoscopic stenting. After initial intervention, the factors predisposing to recurrent biliary obstruction (RBO) were identified via multiple regression analysis.

Results: The final analysis included 28 patients treated with LRYCJ (22.4%) and 97 patients who underwent endoscopic stent insertion (77.6%). The two groups did not differ in the incidence of early or late complications and mortality; however, the LRYCJ group had a lower incidence of RBO (4 patients, 14.3% vs. 73 patients, 75.3%; p < 0.001). As a predisposing factor for RBO, endoscopic stenting was the only highly significant predictor (OR 16.956, CI 5.140-55.935, p < 0.001).

Conclusions: LRYCJ represents an attractive option for palliation of malignant distal biliary obstruction, with improved biliary-tract patency and less need for subsequent interventions such as additional stenting.

Keywords: Biliary tract; Choledochojejunostomy; Laparoscopy; Palliative care; Stents.