Laparoscopic perspectives for XXXX .

@entity1 @entity788 @entity1087 @entity5 @entity190 @entity158 @entity253
BACKGROUND: In @entity1 affected by @entity253 deemed unsuitable for pancreatoduodenectomy, biliary diversion is the only proposable option. Defined goals of this treatment are: relief from @entity1087 preventing its related complications, reduction of in-hospital stay and adequate control of @entity158 . Palliation can be obtained either by surgical or conservative procedures (endoscopic stenting or percutaneous treatment). Considering early complications' incidence, surgical approach has always been reserved for low surgical risk @entity1 with longer survival perspectives, while recently developed long-lasting patency stents enlarged mini-invasive application resort. Comparative studies on these therapeutic options favour the conservative one in respect of conventional open surgery, but data on minimally invasive surgery to pursue palliative aims are lacking. We present our six-years casuistic and results referring to laparoscopic biliary diversions. METHODS: We analyzed results obtained in distal biliary neoplastic obstruction management between December 2008 and November 2014. During this period, selected @entity1 considered unsuitable for pancreatoduodenectomy were scheduled to receive a laparoscopic biliary decompression. Perioperative variables and 30-days postoperative outcomes have been prospectively collected. RESULTS: In the six-years period, 12 @entity1 affected by distal biliary neoplastic obstruction were submitted to laparoscopic palliative bypass. Four procedures were proposed for @entity5 , one for advanced @entity5 and seven for @entity788 . Ten hepatico-jejunal bypasses and two choledochoduodenostomies have been performed. No conversions to open surgery were encountered in this series. Main operative time was 85 min, main @entity190 was 75 ml and main hospitalization was 4.5 days. According to Clavien Dindo Classification one class II and one class IIIb complications occurred. CONCLUSIONS: Although the restricted number of @entity1 , our results suggest that laparoscopic biliary bypass could be a valid option in managing @entity253 , resulting in low perioperative morbidity, effective long term palliation of symptoms and improved quality of life.
