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Bile Duct Bypass

The Experts below are selected from a list of 12 Experts worldwide ranked by ideXlab platform

Paul D Hansen – 1st expert on this subject based on the ideXlab platform

  • cohort study of surgical Bypass to the gallbladder or Bile Duct for the palliation of jaundice due to pancreatic cancer
    Annals of Surgery, 2003
    Co-Authors: David R Urbach, Chaim M Bell, Lee L Swanstrom, Paul D Hansen

    Abstract:

    Jaundice caused by obstruction of the Bile Duct occurs in the majority of patients with pancreatic cancer. 1 Reversal of malignant biliary obstruction provides palliation of jaundice even when a pancreatic tumor is unresectable. 2 Although endoscopic stenting of the Bile Duct can relieve biliary obstruction, 3–6 surgical Bypass is done in many cases because of an inability to access the Bile Duct using endoscopic methods, patient or physician preference, or failure of nonoperative interventions. A biliary Bypass may also be done when a pancreatic tumor proves to be unresectable during an operation intended to remove the tumor.

    Operative Bypass of the biliary system requires establishing continuity between the gastrointestinal tract and a portion of the biliary tree. If the gallbladder is diseased or has been removed, the anastomosis between the intestine and biliary system must be made to the Bile Duct (the hepatic Duct or common Bile Duct). However, when the gallbladder is intact and continuous with the proximal biliary tree, the surgeon has the choice of fashioning an anastomosis either to the gallbladder or to the Bile Duct. Creating an anastomosis to the gallbladder is technically easier than Bypassing to the Bile Duct and is more amenable to a laparoscopic approach. 7,8 In contrast, an anastomosis to the Bile Duct may provide more durable palliation of jaundice. 9 It is not clear whether the choice of biliary Bypass influences survival.

    Previous studies have included too few subjects to provide precise estimates of the relative effectiveness of gallbladder and Bile Duct Bypass. The only randomized trial comparing the two procedures included 31 subjects, of whom only 71% had malignant biliary obstruction. 9 We used Medicare claims data and a population-based cancer registry to study patients with pancreatic cancer 65 years of age or older who initially had a biliary enteric Bypass to either the gallbladder or the Bile Duct without removal of the pancreatic tumor. Our objectives were to determine the relative frequency of the different types of Bypass, and to study patterns of mortality and the use of subsequent biliary drainage procedures.

Robert E. Roses – 2nd expert on this subject based on the ideXlab platform

  • Surgical Palliation for Pancreatic Malignancy: Practice Patterns and Predictors of Morbidity and Mortality
    Journal of Gastrointestinal Surgery, 2014
    Co-Authors: Edmund K. Bartlett, Heather Wachtel, Douglas L. Fraker, Charles M. Vollmer, Jeffrey A. Drebin, Rachel R. Kelz, Giorgos C. Karakousis, Robert E. Roses

    Abstract:

    IntroDuction Most patients with pancreatic cancer present with, or develop, biliary or duodenal obstruction. We sought to characterize palliative surgery utilization in a contemporary cohort and identify patients at high risk of morbidity and mortality. Methods The ACS NSQIP database (2005–2011) was queried for patients with a pancreatic malignancy undergoing gastrojejunostomy, biliary Bypass, or laparotomy without resection. Univariate analysis and multivariate logistic regression identified factors associated with increased risk of 30-day morbidity or mortality. Results Operations for the 1,126 patients undergoing palliative Bypass were gastrojejunostomy alone (33 %), Bile Duct Bypass alone (27 %), both (31 %), or cholecystojejunostomy (9 %). A major complication occurred in 20 % and mortality in 6.5 % at 30 days. Risk factors for morbidity and mortality were defined in multivariate models. The number of identified risk factors stratified morbidity from 14.8–50 % and mortality from 1.6–50 % ( p  

David R Urbach – 3rd expert on this subject based on the ideXlab platform

  • cohort study of surgical Bypass to the gallbladder or Bile Duct for the palliation of jaundice due to pancreatic cancer
    Annals of Surgery, 2003
    Co-Authors: David R Urbach, Chaim M Bell, Lee L Swanstrom, Paul D Hansen

    Abstract:

    Jaundice caused by obstruction of the Bile Duct occurs in the majority of patients with pancreatic cancer. 1 Reversal of malignant biliary obstruction provides palliation of jaundice even when a pancreatic tumor is unresectable. 2 Although endoscopic stenting of the Bile Duct can relieve biliary obstruction, 3–6 surgical Bypass is done in many cases because of an inability to access the Bile Duct using endoscopic methods, patient or physician preference, or failure of nonoperative interventions. A biliary Bypass may also be done when a pancreatic tumor proves to be unresectable during an operation intended to remove the tumor.

    Operative Bypass of the biliary system requires establishing continuity between the gastrointestinal tract and a portion of the biliary tree. If the gallbladder is diseased or has been removed, the anastomosis between the intestine and biliary system must be made to the Bile Duct (the hepatic Duct or common Bile Duct). However, when the gallbladder is intact and continuous with the proximal biliary tree, the surgeon has the choice of fashioning an anastomosis either to the gallbladder or to the Bile Duct. Creating an anastomosis to the gallbladder is technically easier than Bypassing to the Bile Duct and is more amenable to a laparoscopic approach. 7,8 In contrast, an anastomosis to the Bile Duct may provide more durable palliation of jaundice. 9 It is not clear whether the choice of biliary Bypass influences survival.

    Previous studies have included too few subjects to provide precise estimates of the relative effectiveness of gallbladder and Bile Duct Bypass. The only randomized trial comparing the two procedures included 31 subjects, of whom only 71% had malignant biliary obstruction. 9 We used Medicare claims data and a population-based cancer registry to study patients with pancreatic cancer 65 years of age or older who initially had a biliary enteric Bypass to either the gallbladder or the Bile Duct without removal of the pancreatic tumor. Our objectives were to determine the relative frequency of the different types of Bypass, and to study patterns of mortality and the use of subsequent biliary drainage procedures.