The role of prophylactic gastrojejunostomy for unresectable periampullary carcinoma.

One hundred and fifteen patients undergoing palliative bypass for unresectable periampullary carcinoma were reviewed. Postoperative mortality and subsequent length of survival correlated with both presenting symptoms and operative findings. Among 93 patients presenting with biliary obstruction alone, 42 underwent a biliary bypass only and 51, a biliary bypass with a prophylactic gastrojejunostomy. Operative mortality and the postoperative hospital stay were similar for these two groups; postoperative complications tended to be more common in patients undergoing the double bypass. Patients undergoing a biliary bypass alone required significantly more subsequent operations, usually for gastroduodenal obstruction. Thus, it appears that a prophylactic gastrojejunostomy should be performed upon most patients with unresectable periampullary carcinoma presenting with biliary obstruction alone to decrease the number of subsequent palliative operative procedures required.