Palliative treatment of the hepatic hilus through Soupault- Couinaud surgery
DOI:
https://doi.org/10.32635/2176-9745.RBC.1997v43n1.2839Keywords:
Cancer Of The Hepatic Hilus, Palliative Cholangioenteric Anastomosis, Survival, Comfort IndexAbstract
The specialized literature has demonstrated that the survival of the patients with malignant jaundice, even when submited only to palliative treatment, is usually long. The authors present the results of the Soupault-Couinaud's operation, performed as palliative treatment in 17 consecutive patients with malignant jaundice. Among other variables, it was evaluated an index of life quality denominated Comfort Index, allowing for numerical comparison of results. There was an important regression of jaundice in 88.2% of cases, and a statistically relevant reduction of seric levels of bilirubins in the postoperative (P < 0.05). Hospital mortality rate was of 11.8%, and the Comfort Index was of 81.9%. These results allow to state that the proposiet technique represents an effective method for the resolution of cholestasis due to unresectable tumours of the hepatic hilus and that the Cornfort index of 81.9% proves this method to be an adequate pailiarive treatment for malignant jaundice.
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Alterneier. W.A.; Gall.E.A.:zinnjnger, MM.: Hoxworth, P1. - Sclerosing carcinoma of the major intrahepatic biliar ducts. ArchSurg, 75: 450-461, 1957. DOI: https://doi.org/10.1001/archsurg.1957.01280150140015
Klatskin, G. - Adenocarcinoma of the hepatic duct at its bifurcation within the porta hepatis. An unusual tumor with distinctive clinical and pathological features. An J Med, 38: 241-256, 1965. DOI: https://doi.org/10.1016/0002-9343(65)90178-6
Hunt. D.R.: Allison, M.E.M.; Prentice, C.R.M.; Blumgart, L.H. - Endotoxemia, disturbance of coagulation and obstructive jaundice. Ain J Surg, 144: 325-329. 1982. DOI: https://doi.org/10.1016/0002-9610(82)90011-3
Blumgart, L.H.; Benjamin, T.S.; Hadjis, N.S.; Beazley, R. – Surgical approaches to cholangiocarcinoma at confluence of hepatic ducts.Lancet, 14: 66-70, 1984. DOI: https://doi.org/10.1016/S0140-6736(84)90002-3
Shimada, H.: Niimoto, S.; Matsuha, A; Nakagawara, G.; Kobayashi, M.; Tsuchya, S. - Experience with intrahepatic cholangiostomy for unresectable carcinoma of the hepatic hilus. Int Surg, 73: 1-5, 1988.
Bismuth, H.; Castaing, D.; Traynor, O. - Resection or pailiation: priority of treatment of hilar cancer. World J Surg, 12: 39-47, 1988. DOI: https://doi.org/10.1007/BF01658484
Cotton, P.B. - Duodenoscopic placement of biliary prosthesis to relieve malignant obstructive jaundice. Br J Surg, 69: 501-503, 1982. DOI: https://doi.org/10.1002/bjs.1800690902
Dooley, J.S.; Dick, R.; Irving, D.; Olney, J.; Sherlock, S. - Relief of bile duct obstruction by the percutaneous trans hepatic insertion of an endoprosthesis. Clin Radiol, 32: 163-172, 1981. DOI: https://doi.org/10.1016/S0009-9260(81)80153-5
Burcharth, F.; Efsen, F.; Cristiansen. L.A. et al. - Nonsurgical internal hiliary drainage by endoprosthesis. Surg Gynecol Obstel, 857-860, 1981.
Pereira-Lima, L.: Waechter, F.L. - Conduta nos colangiocarcinomas do hilo hepático. In: Pereira-Lima, L. (Ed.) Condutas na cirurgia hepatobiliopancreática. Rio de Janeiro: Editora Medsi. pp. 207-222. 1995.
Soupault. R.; Couinaud. C. - Surun procédé nouveau de dérivation biliare intra-hepatique - Les cholangiojéjunostomies gauches sans sacrifice hépatigue. Presse Med,65:1 157-1 159.1957.
Praderi, R.C.: Estefan, A.F.: Tiscornia. E. - Transhepatic intubation in benign and malignant lesions of the biliary ducts. Curr Proh Surg, 22: 1-88. 1985. DOI: https://doi.org/10.1016/0011-3840(85)90010-3
Pereira-Lima, L. - Importância dos tubos transepáticos no tratamento cirúrgico das lesões altas da via biliar principal. Tese de Livre Docência. Porto Alegre, RS, 1989.
Pappaiardo, G.; Correnti, S.; Mobarhan. S. et ai. - Long-term results of Roux-en-y hepaticojejunostomy and hapaticojejunoduodenostomy. Ann Surg, 196: 149-152, 1982. DOI: https://doi.org/10.1097/00000658-198208000-00006
Spsini, R.; Lijoi, C.; Nervi, M.; Caldarelli, G.F.; Colizzi, C. - L'epatico-digiunostomia su ansa alia Roux nella patologia benigna deila via biliare principale. Miner Chirur, 44: 1547-1551, 1989.
Pereira-Lima, L. - Biliary reconstruction in benign postoperative stricture with trashepatic tubes.A,n J Surg, 164: 124-128, 1992. DOI: https://doi.org/10.1016/S0002-9610(05)80369-1
Longmire, W.P.; Sandford, M.C. - Intrahepatic cholangiojejunostomy with partial hepatectomy for biliary obstruction. Surgery, 24: 264-276, 1948.
Dogliotti, A.M.; Fogliati, E. - Operations for fibrous stenosis of the common bile duct. Surgery, 1: 69-79, 1954.
Hepp, J; Couinaud, C. - L'abord et I'utilisation du canal hépatique gauche dans les réparations de la voie biliare principale. Presse Med, 64: 947-948, 1956.
Prioton, J.B.; Bernard, J.H.; Serrou, B. - La double cholangio-jéjunosto-mie périphérique (droite e gauche) dans le traitement des cancers primitifs du confluent biliiaire supérieur. Montepellier Chir, 14: 317-355, 1968.
Blumgart, L.H.; Kelley, C.L. - Hepaticojejunostomy in benign and malign bile duct stricture: approaches to the Ieft hepatic ducts. BrJSurg, 71: 257-261, 1984. DOI: https://doi.org/10.1002/bjs.1800710403
Gilmartin, D.; Osborne, D.H.; Lane, B.E. - Biliary decompression via a Ieft hepatic duct. I.J.M.S. 1985; (october): 397-400. DOI: https://doi.org/10.1007/BF02937190
White, T.T. - Skeletization resection and central hepatic resection in the treatment of bile duct cancer. World J Surg, 12: 48-5 1, 1988. DOI: https://doi.org/10.1007/BF01658485
Longmire, W.P.; McArthur, M.S. Bastounis, E.A.; Hiatt, J. - Carcinoma of the extrahepatic biliary tract. Ann Surg, 178: 333-345, 1973. DOI: https://doi.org/10.1097/00000658-197309000-00013
Camprodon, R.; Salva, J.A.; Jornet, J.; Guerrero, J.A. - Successfull resection of carcinoma of the common hepatic duct at its superior bifurcation. Am J Surg, 128: 433-435, 1974. DOI: https://doi.org/10.1016/0002-9610(74)90187-1
Launois, B.; Campion, J.P.; Brissot, P.; Gosselin, M. - Carcinoma of the hepatic hilus: surgical management and the case for resection.Ann Surg, 190: 151- 157, 1979. DOI: https://doi.org/10.1097/00000658-197908000-00005
Reding, R.; Buard, J.L.; Lebeau, G.; Lanouis, B. - Surgical management of 552 carcinomas of the extrahepatic bile ducts (Gallbladder and peri ampulary tumor excluded).Ann Surg, 23:236-24, DOI: https://doi.org/10.1097/00000658-199103000-00010
Tashiro, S. Tsuji, T. Kanemitsu, K.; Kamimoto. Y.; Hiraoka, T.; Miyauchi. Y. - Prolongation of survival for carcinoma at the hepatic confluence. Surgery, 113: 270-278, 1993.
Lygidakis, N.J.; Heyde, M.N.; Houthoff, H.J. - Surgical approaches to the management of primary biliary cholangiocarcinoma of the porta hepatis: The decision making dilemma. Hepato Gastroenterol, 35: 262-267, 1988.
Nakayama, T.; Ikeda, A.; Okuda, K. - Percutaneous transhepatic drainage of the biliary tract.Gastroenterology, 74: 554-559, 1978. DOI: https://doi.org/10.1016/0016-5085(78)90295-0
Hatfield, A.R.W.; Terbianche, J.; Fataar, S. et al. - Preoperative biliary drainage in obstructive jaundice: a prospective controlled clinical trial. Lancet, 2: 896-899, 1982. DOI: https://doi.org/10.1016/S0140-6736(82)90866-2
McPherson, G.A.D.; Benjamin, IS.; Hodgson, H.J.F.; Bowley, N.B.; Allison, D.J.; Blumgart, L.H. – Preoperative percutaneous transhepatic biliary drainage: The results of a controlled trial. Br J Surg, 71: 371-375, 1984. DOI: https://doi.org/10.1002/bjs.1800710522
Malt, R.A.; Warshaw, A.L.; Jamieson, C.G.; Hawk III, J.C. - Left intrahepatic cholangiojejunostomy for proximal obstruction of the biliary tract. Surg Gynecol Obstet, 150: 193-197, 1980.
Ottow, R.T.; August, D.A.; Sugarbaker, P.H. - Treatment of proximal biliary tract carcinoma: An overview of techniques and results. Surgery, 97: 251-262, 1985.
Laurence, B.H.; Cotton, P.B. - Decompression of malignant biliary obstruction by duodenoscopic intubation of bile duct. Br Medi, 23: 522-523, 1980. DOI: https://doi.org/10.1136/bmj.280.6213.522
Huibregtse, K.; Tygat, G.N.T. -Endoscopic placement of biliary prosthesis. In: Salmon, P. (Ed.) Advances in gastrointestinal endoscopy. London: Chapmam e Hall Ltd. 1984; pp. 219-231.
Terbianche, J.; Low, J.H. - U-tube drainage in the paliative therapy of carcinoma of the main hepatic ductjunction. Surg ClinNAm, 53: 1245-1256, 1973. DOI: https://doi.org/10.1016/S0039-6109(16)40150-7
Tsuzuki, T.; Uekusa, M. – Carcinoma of the proximal bile ducts. Surg Gynecol Obstet, 146: 933-943, 1978.
Pereira-Lima, L.; Falavigna, L.; Kalil, A.N. - Drainage auxilliaire sur le parcours intrapéritoneal des tubes transhépatiques dans les sténoses benignes de la voie biliaire principale. J Chirur (Paris), 128: 153-155, 1991.
Couinaud, C. - Lobes et segments hépatiques. Notes sur 1'architecture anatomique et chirurgicale du foje. Presse Med, 62. 709-712, 1954.
Bismuth, H.; Corlette, M.B. - Intrahepatic cholangioenteric anastomosis in carcinoma of the hilus of the liver. Sur Gynecol Obstet, 140: 170-178, 1975.
Evander, A.; Fredlung, P.; Hoevels, J.; Ihse, I.; Bengmark, S. - Evaluation of agressive surgery for carcinoma of the extrahepatic bile duct. Ann Surg, 191: 23-29, 1980. DOI: https://doi.org/10.1097/00000658-198001000-00005
