[Efficacy of biliary by-pass operations in carcinoma of the head of the pancreas with jaundice (author's transl)].

In the present state of detection and treatment of carcinoma of the head of the pancreas, only palliative surgery is available. The debate concerning the type of bilio-digestive by-pass is far from closed. Although by-passes using the gall bladder remain rare in France, above all reserved for advanced cancer, we prefer to use the common bile duct. The choice of the by-pass depends mainly on the local conditions and on the general state of the patient. Side-to-side choledoco-duodenal anastomosis, provided the technic is perfect and there is no duodenal obstruction, remains the simplest and therefore the most commonly used by-pass. However in cases of large pancreatic carcinomas modifying the relations between the duodenum and the bile duct or stenosing the duodenum, or as a routine whenever possible, it seems to us advisable to undertake a choledoco-jejunostomy on a Y loop (the raised loop is also used for a gastrojejunostomy), and this seems to give the most rapid recovery from the jaundice, a low mortality and ensure the longest survival.