Segment III bypass: An Option to Palliate Proximal Biliary Obstruction

Introduction: In the era of minimally invasive therapy, endoscopic or interventional radiological techniques have become preferred technique for palliating advanced malignant hilar obstruction due to carcinoma gallbladder or cholangiocarcionmas. However, in selected group of these locally advanced...

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Autor principal:	Ramesh Singh Bhandari
Formato:	article
Lenguaje:	EN
Publicado:	Society of Surgeons of Nepal 2018
Materias:	Malignancy Hilar obstructions Segment III bypass Surgery RD1-811
Acceso en línea:	https://doaj.org/article/54b8847d42674c448cd88bf2179e663e
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spelling	oai:doaj.org-article:54b8847d42674c448cd88bf2179e663e2021-12-05T19:15:57ZSegment III bypass: An Option to Palliate Proximal Biliary Obstruction10.3126/jssn.v21i1.243711815-39842392-4772https://doaj.org/article/54b8847d42674c448cd88bf2179e663e2018-06-01T00:00:00Zhttps://www.nepjol.info/index.php/JSSN/article/view/24371https://doaj.org/toc/1815-3984https://doaj.org/toc/2392-4772 Introduction: In the era of minimally invasive therapy, endoscopic or interventional radiological techniques have become preferred technique for palliating advanced malignant hilar obstruction due to carcinoma gallbladder or cholangiocarcionmas. However, in selected group of these locally advanced unresectable disease and fit patients, surgical segment III bypass could still be a viable option for palliation. Methods: I retrospectively reviewed the medical records of all the patients of segment III bypass performed over last six years (Oct 2012- May 2018) and analyzed the indication, perioperative morbidity, symptom relief and survival. Results: Total 17 patients underwent palliative biliary bypass over the specified period. Among them 8 patients underwent segment three III biliary bypass for proximal biliary obstruction. Except 1 patient, all segment three bypass were offered to malignant proximal biliary obstruction. One patient developed postoperative sepsis and had mortality on day 7. Symptom relief in the form of relief of pruritus, improved sleep pattern and improved appetite was seen in 5 patients. In remaining 2 patients, the bilirubin didn’t drop to normal level and the symptom reliefs were partial. However, the patient had good satisfaction over not having an external tube attached to their body. Despite the patent anastomosis, failure in dropping bilirubin level significantly was considered due to segmental obstructions. One patient survived for 18months, 1 had follow up to 13 months. Three patients were lost to follow up after 3 months. Two patients had six weeks follow up and were symptomatically doing better. Conclusion: Surgical segment III bypass is still a good option for palliating malignant hilar obstruction in selected group of patients. Ramesh Singh BhandariSociety of Surgeons of NepalarticleMalignancyHilar obstructionsSegment III bypassSurgeryRD1-811ENJournal of Society of Surgeons of Nepal, Vol 21, Iss 1 (2018)
institution	DOAJ
collection	DOAJ
language	EN
topic	Malignancy Hilar obstructions Segment III bypass Surgery RD1-811
spellingShingle	Malignancy Hilar obstructions Segment III bypass Surgery RD1-811 Ramesh Singh Bhandari Segment III bypass: An Option to Palliate Proximal Biliary Obstruction
description	Introduction: In the era of minimally invasive therapy, endoscopic or interventional radiological techniques have become preferred technique for palliating advanced malignant hilar obstruction due to carcinoma gallbladder or cholangiocarcionmas. However, in selected group of these locally advanced unresectable disease and fit patients, surgical segment III bypass could still be a viable option for palliation. Methods: I retrospectively reviewed the medical records of all the patients of segment III bypass performed over last six years (Oct 2012- May 2018) and analyzed the indication, perioperative morbidity, symptom relief and survival. Results: Total 17 patients underwent palliative biliary bypass over the specified period. Among them 8 patients underwent segment three III biliary bypass for proximal biliary obstruction. Except 1 patient, all segment three bypass were offered to malignant proximal biliary obstruction. One patient developed postoperative sepsis and had mortality on day 7. Symptom relief in the form of relief of pruritus, improved sleep pattern and improved appetite was seen in 5 patients. In remaining 2 patients, the bilirubin didn’t drop to normal level and the symptom reliefs were partial. However, the patient had good satisfaction over not having an external tube attached to their body. Despite the patent anastomosis, failure in dropping bilirubin level significantly was considered due to segmental obstructions. One patient survived for 18months, 1 had follow up to 13 months. Three patients were lost to follow up after 3 months. Two patients had six weeks follow up and were symptomatically doing better. Conclusion: Surgical segment III bypass is still a good option for palliating malignant hilar obstruction in selected group of patients.
format	article
author	Ramesh Singh Bhandari
author_facet	Ramesh Singh Bhandari
author_sort	Ramesh Singh Bhandari
title	Segment III bypass: An Option to Palliate Proximal Biliary Obstruction
title_short	Segment III bypass: An Option to Palliate Proximal Biliary Obstruction
title_full	Segment III bypass: An Option to Palliate Proximal Biliary Obstruction
title_fullStr	Segment III bypass: An Option to Palliate Proximal Biliary Obstruction
title_full_unstemmed	Segment III bypass: An Option to Palliate Proximal Biliary Obstruction
title_sort	segment iii bypass: an option to palliate proximal biliary obstruction
publisher	Society of Surgeons of Nepal
publishDate	2018
url	https://doaj.org/article/54b8847d42674c448cd88bf2179e663e
work_keys_str_mv	AT rameshsinghbhandari segmentiiibypassanoptiontopalliateproximalbiliaryobstruction
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Segment III bypass: An Option to Palliate Proximal Biliary Obstruction

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