Intrahepatic segment III cholangiojejunostomy in advanced carcinoma of the gallbladder

✍ Scribed by Mr V. K. Kapoor; R. Pradeep; S. P. Haribhakti; V. Singh; S. S. Sikora; R. Saxena; S. P. Kaushik

• Publisher: John Wiley and Sons
• Year: 1996
• Tongue: English
• Weight: 354 KB
• Volume: 83
• Category: Article
• ISSN: 0007-1323
• DOI: 10.1002/bjs.1800831215

✦ Synopsis

The majority of patients with advanced carcinoma of the gallbladder have irresectable disease and require palliation for jaundice, pruritus and cholangitis. Intrahepatic segment 111 cholangiojejunostomy has been described for palliation of high biliary obstruction in these patients. Forty-one patients with stage IV gallbladder cancer underwent intrahepatic segment I11 cholangiojejunostomy. Subsequent jaundice, pruritus and cholangitis were documented; liver function tests and isotope hepatobiliary scans were performed. All patients had jaundice, 29 had pruritus and 12 had cholangitis. Postoperative complications included anastomotic leak in six patients and wound infection in six. Five patients died within 30 days of operation. Thirty-two patients were available for follow-up. The procedure failed to relieve jaundice, pruritus or cholangitis in four patients; 18 were free of jaundice, pruritus and cholangitis until death or last follow-up, and ten had recurrent jaundice or cholangitis. Isotope scanning was found to be useful to predict success of the procedure. Intrahepatic segment I11 cholangiojejunostomy provided excellent palliation from jaundice, pruritus and cholangitis with acceptable mortality and morbidity rates in patients with advanced carcinoma of the gallbladder.

Carcinoma of the gallbladder is the commonest biliary tract malignancy. Unfortunately most patients have advanced disease at the time of diagnosis. Jaundice is common, and pruritus and cholangitis are distressing associated features. A large single-centre experience with intrahepatic segment I11 cholangiojejunostomy for palliation of these symptoms in patients with advanced gallbladder cancer is presented.