A prospective, randomized clinical investigation ofcholecystoenterostomy and choledochoenterostomy

Sarfeh, I. James; Rypins, Eric B.; Jakowatz, James G.; Juler, George L.

doi:10.1016/s0002-9610(88)80102-8

Cited by 93 publications

(40 citation statements)

References 8 publications

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“…Si no se realiza la gastroyeyunostomía en el momento de la derivación biliar, 13% a 21% requerirán la misma (24,25) . Un ensayo controlado aleatorizado confirma que 19% de los pacientes requieren intervención por obstrucción duodenal cuando son aptos para el procedimiento quirúrgico (26) . Nosotros realizamos derivación gástrica solo en aquellos pacientes con síntomas de estenosis gastroduodenal clínicamente manifiesta o hallazgos endoscópicos de obstrucción duodenal.…”

Section: Discussionunclassified

Cáncer de páncreas. Epidemiología de su mal pronóstico

Penza

Martínez

2017

RMU

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ResumenIntroducción: el cáncer de páncreas se caracteriza por su agresividad biológica, mal pronóstico oncológico y diagnóstico tardío. La mayoría con baja tasa de resecabilidad (10% a 20%), por la presencia de factores de irresecabilidad al momento del diagnóstico.Objetivo: descripción epidemiológica de las características del cáncer de páncreas irresecable, los tratamientos paliativos realizados, la sobrevida global y en relación con los procedimientos realizados.Material y método: estudio descriptivo, multivariable, retrospectivo de los cánceres de páncreas irresecables, de enero de 2010 a diciembre de 2015, en la Clínica Quirúrgica 3 del Hospital Maciel.Resultados: de los 30 pacientes irresecables: igual distribución por sexo; edad promedio: 61 años, cefálicos en 67% de los casos. El 53% adelgazados al momento de la primera consulta; 52% presentaban compromiso ganglionar locorregional, y 50% presentaba metástasis hepáticas o ascitis. A 52% de los pacientes se les realizó algún tipo de derivación biliar; quirúrgi-ca en 53% (63% coledocoduodenostomías) y el resto percutánea o endoscópica. El 31% de los pacientes, por lo avanzado de la enfermedad, no recibió tratamiento quirúrgico ni endoscópico. La sobrevida media del tratamiento paliativo quirúrgico o endoscópico fue de 3,7 meses.Conclusiones: al momento del diagnóstico, la mitad de los casos tenían metástasis y repercusión nutricional severa, con indicadores locorregionales de irresecabilidad o incurabilidad. Un tercio de los casos no recibió tratamiento oncológico por lo avanzado de la enfermedad. La sobrevida global fue escasa. Esto permite sugerir que son imprescindibles medidas sanitarias para su diagnóstico precoz e incremento de la tasa de resecabilidad.

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Section: Discussionunclassified

Cáncer de páncreas. Epidemiología de su mal pronóstico

Penza

Martínez

2017

RMU

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“…Addressing this concern, Sarfeh et al concluded that choledochoenterostomy is significantly a more effective method of palliation than one involving the use of the gallbladder; describe it as the procedure of choice 10. In a recent study comparing cholecystojejunostomy with choledochojejunostomy in patients with unresectable pancreatic cancer, Urbach et al concluded that there was 4.4 times increase in the risk of requiring a subsequent biliary drainage procedure in the cholecystojejunostomy group 12.…”

Section: Discussionmentioning

confidence: 99%

Hepaticocholecystoduodenostomy compared with Roux-en-y choledochojejunostomy for decompression of the biliary tract

Shah

Zargar

2009

Annals of Saudi Medicine

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BACKGROUND AND OBJECTIVES:The nature of palliative decompressive surgery for unresectable periampullary tumor is usually determined by the experience of the surgeon. We compared hepaticocholecystoduodenostomy (HCD), a new palliative decompressive anastomotic technique, to Roux-en-y choledochojejunostomy (CDJ) in this prospective, randomized study.PATIENTS AND METHODS:Twenty patients who were to undergo surgery for palliative bypass were randomized into two groups: group I was subjected to HCD (10 patients) and group II to CDJ (10 patients). Pre- and postoperative liver function tests, operative time, operative blood loss, onset of postoperative enteral feeding, length of hospital stay and survival rates were compared in the two groups.RESULTS:Effective surgical decompression was observed clinically as well as on analysis of pre- and postoperative liver function tests in both the groups. The results were statistically significant in favor of patients in group I when compared to those of group II with respect to operative time 84.7 (10.3) min vs 133.6 (8.9) min; P =<.0001), operative blood loss 137.8 (37.2) mL vs 201.6 (23.4) mL; P =.001), postoperative enteral feeding 3.3 (0.5) days vs 5.0 (0.7) days; P=<.0001) and length of hospital stay 7.5 (0.7) days vs 9.7 (1.2) days; P=<.0001). During follow-up, recurrent jaundice was observed in one patient in group I and two patients in group II, while duodenal obstruction developed in one patient in the group I series. Gastrointestinal hemorrhage occurred in one patient belonging to group II. The difference in mean survival time was not statistically significant.CONCLUSION:Based on this small series, HCD seems to be a better palliative surgical procedure than the routinely performed CDJ.

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“…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.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Discussionmentioning

confidence: 99%

“…These findings are consistent with previous observations suggesting that bile duct bypass provides more durable palliation of obstructive jaundice than gallbladder bypass. 9,24,25 Despite the strong advocacy of influential surgeons that bypass to the bile duct is superior to gallbladder bypass for malignant biliary obstruction, 24,25 gallbladder bypass continues to be performed frequently in the United States. About half of the subjects in our cohort had their initial bypass to the gallbladder.…”

Section: Discussionmentioning

confidence: 99%

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