Concomitant laparoscopic gastric and biliary bypass and bilateral thoracoscopic splanchnotomy: the full package of minimally invasive palliation for XXXX .

@entity1 @entity3883 @entity788 @entity1087 @entity5 @entity3085 @entity189 @entity615 @entity1321 @entity158
INTRODUCTION: @entity788 is unresectable in 80% or more of @entity1 . @entity615 are the most common complications of the disease. These complications may be palliated effectively using minimally invasive techniques. Their combined application in a single setting is presented and discussed in this article. CASE REPORT: A 59-year-old @entity1 with a locally advanced @entity189 of the head of the pancreas presented @entity3883 and intractable @entity158 requiring opiate analgesia. An attempt at endoscopic biliary stenting was unsuccessful, and a percutaneous biopsy was deemed unsafe. Preoperative magnetic resonance cholangiography showed cystic duct insertion abutting the upper limit of the biliary stricture. A laparoscopic Roux-en-Y hepaticojejunostomy, prophylactic loop gastroenterostomy, and @entity5 biopsy were combined with a bilateral thoracoscopic splanchnotomy. RESULT: Surgery and subsequent recovery were uneventful, and the @entity1 was discharged from hospital on the fourth postoperative day off opiates. He remained free of @entity1087 and severe @entity158 , until 6 months later, when he represented with @entity1087 , @entity3085 , and proximal small bowel obstruction secondary to multiple liver and peritoneal metastases. He underwent further palliative laparoscopic enteric bypass with resolution of the @entity1321 , but died of the disease 10 days later. CONCLUSION: Laparoscopic gastric and biliary bypass and bilateral thoracoscopic splanchnotomy may be safely combined to provide an effective comprehensive minimally invasive palliation of incurable @entity788 .
