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Palliative laparoscopic Roux-en-Y choledochojejunostomy as a feasible treatment option for malignant distal biliary obstruction

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Abstract

Purposes

The advantages of surgical bypass for patients with distal biliary obstruction caused by advanced periampullary cancer include a low risk of recurrent biliary obstruction; however, the highly invasive nature of the operation limits its use. Herein, we present the clinical findings of patients who underwent laparoscopic Roux-en-Y choledochojejunostomy (LRYCJ) compared with those who underwent endoscopic stent insertion.

Methods

We reviewed, retrospectively, the palliative care outcomes for malignant bile duct obstruction according to the type of intervention: LRYCJ vs. endoscopic stenting. After initial intervention, the factors predisposing to recurrent biliary obstruction (RBO) were identified via multiple regression analysis.

Results

The final analysis included 28 patients treated with LRYCJ (22.4%) and 97 patients who underwent endoscopic stent insertion (77.6%). The two groups did not differ in the incidence of early or late complications and mortality; however, the LRYCJ group had a lower incidence of RBO (4 patients, 14.3% vs. 73 patients, 75.3%; p < 0.001). As a predisposing factor for RBO, endoscopic stenting was the only highly significant predictor (OR 16.956, CI 5.140–55.935, p < 0.001).

Conclusions

LRYCJ represents an attractive option for palliation of malignant distal biliary obstruction, with improved biliary-tract patency and less need for subsequent interventions such as additional stenting.

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Data availability

The research data that support the findings of this study are available on request from the corresponding author. The research data are not publicly available for privacy or ethical restrictions.

Abbreviations

GBP :

Gallbladder polypoid lesion

TG :

Triglycerides

ROC :

Receiver-operating characteristic

OR :

Odds ratio

MUC :

Gallbladder mucin

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Acknowledgements

No additional investigators were involved in this research project.

Funding

The authors received no specific funding for this work.

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Authors and Affiliations

  1. Division of Trauma and Surgical Critical Care, Department of Surgery, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Republic of Korea

    Eun Young Kim

  2. Division of Hepato-Biliary and Pancreas Surgery, Department of Surgery, Bundang Jesaeng Hospital, Seongnam, Republic of Korea

    Soo Ho Lee

  3. Division of Hepato-Biliary and Pancreas Surgery, Department of Surgery, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, Republic of Korea

    Tae Ho Hong

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  1. Eun Young Kim
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Contributions

Study conception and design: EYK, SHL, HTH. Acquisition of data: EYK, SHL. Statistical analysis: EYK. Analysis and interpretation of data: EYK. Drafting of the manuscript: EYK. Critical revision: EYK, HTH. Guarantor of the article: HTH. All authors approved the final version of the article, including the list of authors.

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Correspondence to Tae Ho Hong.

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Kim, E.Y., Lee, S.H. & Hong, T.H. Palliative laparoscopic Roux-en-Y choledochojejunostomy as a feasible treatment option for malignant distal biliary obstruction. Surg Today 52, 1568–1575 (2022). https://doi.org/10.1007/s00595-022-02513-8

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  • DOI: https://doi.org/10.1007/s00595-022-02513-8

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