Objective: To determine the efficacy of hepatico-jejunostomy as a method of successful decompression of the biliary tree in cases of proximal bile duct obstruction. Design & Duration: Descriptive, retrospective study from 1993 to 2003. Setting: Civil Hospital, Karachi. Patients: 77 patients who presented with proximal bile duct obstruction during the above mentioned period. Methodology: The data of all the 77 patients was analyzed as regards to presentation, treatment, and the outcome. Results: Proximal bile duct obstruction was seen in 44 benign and 33 malignant cases. The benign cases were due to post-cholecystectomy trauma while the malignant cases were due to cholangiocarcinoma. Hepatico-jejunostomy with different approaches like anastomosis of Common Hepatic Duct(CHD) to jejunum (n-40), Right & Left Hepatic Duct(HD) to jejunum (n-28), only Left Hepatic Duct to jejunum - Segment III approach (n-6) and Ligamentum Teres approach (n-3) were adopted after curative resection in 52 (67.53%) and palliative resection in 25 (32.47%) patients. A marked decrease in cholestasis to almost normal level was achieved when CHD or/and LHD both were involved, whereas significant decrease was observed when only LHD was used for anastomosis; 79% cases had little or no clinical symptoms like jaundice or pruritis. The overall 5-year survival in malignant cases was around 15%. Conclusion: Hepatico-jejunostomy is a feasible and reasonably effective treatment procedure following curative or palliative resection. The patients were significantly relieved from cholestasis and symptoms of jaundice or pruritis. Although complete decompression was rarely achieved in malignant cases, near normal levels were achieved in benign cases.
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