Management of Malignant Obstructive Jaundice

Abstract

Malignant obstructive jaundice (MOJ) constitutes an important surgical problem with high morbidity and mortality worldwide. Presentation is usually delayed with a majority of patients benefitting only from palliative treatment. Surgeons practicing in developing countries face herculean task in managing MOJ due to lack of minimally invasive endoscopic procedures. Palliative surgical procedures are associated with high morbidity and sometimes mortality. Abdominal pain, generalized pruritus, and gastric outlet obstruction are some of the symptoms of MOJ requiring palliation. Successful surgical palliation may improve the overall quality of life in patients with MOJ considered fit for surgery. Bypass procedures and regional nerve blocks constitute the most effective surgical palliation available to surgeons practicing in resource-limited settings. This review article discusses the indications, the role, and types of surgical bypass procedures in the management of MOJ in contemporary surgical practice. This is important for surgeons in countries where expertise and resources for the less morbid endoscopic and radiologic approaches are not available. Relevant articles up to January 2021 published in PubMed, Google Scholar, and Hinari on the surgical management of obstructive jaundice were reviewed for inclusion. We also reviewed some modern surgical textbook topics on obstructive jaundice.

Correlation between functional drainage and survival in malignant biliary obstruction after percutaneous biliary drainage

“…Malignant biliary obstruction (MBO) is a severe complication of advanced malignant tumors caused by local invasion or compression of the intrahepatic or extrahepatic bile ducts [ [1] , [2] , [3] ]. Jaundice is MBO's most typical clinical manifestation, which is usually found in patients with hepatobiliary cancer, pancreatic cancer, and lymph node metastases of other tumors such as gastric and colon cancer [ [4] , [5] , [6] ]. MBO markedly affects the quality of life of patients, causing a loss of appetite, very symptomatic pruritus, steatorrhea, and even cachexia [ 7 ].…”

Pathophysiological consequences and treatment strategy of obstructive jaundice

“…The occurrence of jaundice is also related to genetic factors[ 8 ]. Common bile duct stones are undoubtedly the leading cause of extrahepatic biliary obstruction, and bile duct cancer, malignancies such as periampullary and pancreatic cancer, and benign strictures including chronic pancreatitis have become increasingly common[ 9 - 11 ].…”