Biliary bypass surgery – Analysis of indications & outcome of different procedures

Objectives: this study reports the indications and outcome of various biliary bypass surgical procedures from a single centre over a period of 10 years. methods: this is a prospective observational study conducted over a period of 10 years (january 2001-december 2010). a total of 1500 patients were included, who underwent pancreatico-biliary surgery due to common bile duct (cbd) stones, congenital anomalies of biliary tree, unoperable pancreatico-biliary malignancies, cbd strictures and cases who developed iatrogenic biliary injuries during cholecystectomy (both open & laproscopic) during this period of time. the patients who required biliary bypass surgery were further analysed for indications and outcome.results: out of 1500 patients 83(5.53%) required biliary bypass surgical procedures. the cbd stones were observed as the most common indication (25.3%), followed by cbd injuries after open(10.84%) or laproscopic-cholecystectomy (14.46%), carcinoma head of pancreas (12.05%) and cbd obstruction(14.46%) either due to cbd strictures or unknown distal obstruction. roux-en-y-hepatico-jejunostomy (26.51%) was the most frequently performed procedure, followed by choledochoduodenostomy and roux-en-y choledocho-jejunostomy (i.e. 25.3% and 12.05% respectively). roux-en-y biliary bypass procedure was observed to be associated with better outcome in terms of rate of complications as well duration of hospital stay. conclusion: biliary bypass surgical procedures are the better options to restore the continuity of biliary system in patients with iatrogenic biliary tree injuries and un-operable pancreatico-biliary malignancy. roux-en-y biliary bypass procedure is safe and problem solving method in these cases