Intrahepatic anastomoses for malignant and benign biliary obstruction.

OBJECTIVE

To assess the role, techniques, and outcome of intrahepatic biliary anastomoses in patients undergoing resective or palliative surgery at the hepatic hilum.

DESIGN

A retrospective review over a 23-year period of all patients undergoing intrahepatic bilioenteric anastomoses.

SETTING

A major university teaching hospital in France.

PATIENTS AND INTERVENTIONS

Over a 23-year period, 59 patients (19 with palliative, 35 with curative, and five with benign disease) underwent intrahepatic bilioenteric anastomoses.

MEASUREMENTS AND RESULTS

There was a hospital mortality of six for the palliative group and four for the curative group. A significant fall in both the serum bilirubin and alkaline phosphate levels occurred after surgery (P < .5). Long-term follow-up was possible in 44 patients. Recurrent stenosis due to recurrent disease occurred in 100% of the palliative group and 69% of the curative group. There were two stenoses in four patients with benign disease. Recurrent cholangitis developed in 37 patients, five without apparent stenosis. The median survival for the palliative group was 6 months (range, 2 days to 13 months) and for the curative group, 21.7 months (range, 0.5 to 148 months); all the benign group remain alive.

CONCLUSIONS

Despite the advent of modern endoscopic and percutaneous intubation techniques, intrahepatic anastomoses after tumor resection offer the only chance of cure for obstructing hilar malignant disease.