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Year : 2019  |  Volume : 38  |  Issue : 1  |  Page : 142-154

Dual stenting for both CBD and duodenum versus surgical bypass in the management of advanced head of pancreas cancer

Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt

Correspondence Address:
Ahmed Yahia
MD in General Surgery, Postcode 44511
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ejs.ejs_152_18

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Background As 70–90% of patients with carcinomas of the head of the pancreas and ampullary region have jaundice at presentation and going to have gastric outlet obstruction, palliation that ensures biliary and gastric drainage represents a large proportion of the hepatobiliary surgeon’s workload. As barely 20% of patients with pancreatic cancer are suitable for curative resection, good palliative therapy is extremely important. Aim of the work To compare the effectiveness of palliation between patients with advanced head of pancreas cancer who underwent surgical bypass and those who underwent dual stenting and morbidity and mortality rates of both procedures. Patients and methods This prospective study was conducted between April 2015 and April 2017. Only 38 patients were eligible for this study. Follow-up was at 1, 3, and 6 months after each procedure. Evaluation of patients regarding efficacy and feasibility, morbidity, mortality, hospital stay, ICU admission, readmission rate, and survival was done. Results We identified 38 patients, of whom 19 underwent endoscopic stenting and 19 underwent a surgical bypass either by choledechojejunostomy or cholecystojejunostomy-en-Y with gastrojejunostomy. There were no significant differences in complications or mortality rates; however, all results were in favor of dual stenting, owing to short procedure time, hospital stay, ICU admission, and survival rates being better than surgical bypass, although without significance. Conclusion Dual stenting was found to be more feasible and efficient in palliation of advanced head of pancreas cancer with short procedure time and short hospital stay and less morbidity and mortality and ICU admission with higher cost in comparison with surgical bypass. Surgical bypass is mandatory in patient with gastric outlet obstruction or failed Endoscopic Retrograde Cholangiopancreatography (ERCP) trial due to huge mass obstructing the duodenum.

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