Background: The majority of patients with upper gastrointestinal (UGI) tract malignancy present
at a stage where cure of disease is not possible. The aim of treatment in these patients is effective
palliation. Various interventions have been described for the palliation of biliary and gastric outlet
obstruction including open surgery, endoscopic and transparietal stent placement. Laparoscopic bypass
appears to have the advantage of decreased postoperative pain and shorter hospital stay as
well as offer effective palliation. The aim of this study was to assess the safety and efficacy of laparoscopic
bypass in patients with incurable UGI tract malignancy.
Patients and Methods: Between August 2000 and April 2002 laparoscopic gastric and biliary bypass
concurrently or alone was attempted in 19 consecutive patients with unresectable carcinoma
of the head of the pancreas, adenocarcinoma of the stomach, cholangiocarcinoma of the distal common
bile duct, or adenocarcinoma of the duodenum. The operative time, length of postoperative
stay, complications, and the effectiveness of the procedure in terms of the ability to sustain oral nutrition
and or the relief of obstructive jaundice were recorded and used as outcome measures.
Results: Laparoscopic bypass was successful in 18 out of 19 cases. The mean operative time for a
single bypass was 164 minutes while the average postoperative hospital stay was 11 days. All patients
were able to sustain oral nutrition during the course of their hospital stay and or had effective
relief from their obstructive jaundice. Two patients died from procedure unrelated causes within
30 days of the operation.
Conclusion: Laparoscopic bypass appears to be a safe and effective means of palliation for patients
with unresectable UGI tract tumors and should replace open surgical palliation in this group
of patients.
