Radiology, Vol 204, 780-786, Copyright © 1997 by Radiological Society of North America
Left hepaticogastrostomy for biliary obstruction: long-term results
G Soulez, E Therasse, VL Oliva, A Pomp, S Busque, M Dagenais, E Deslandres, G Ghattas and M Gagner
Department of Radiology, University of Montreal, Centre Hospitalier, Quebec, Canada.
PURPOSE: To evaluate the long-term results of peripheral biliary diversion
by means of anastomoses of the left lobe of the liver to the stomach.
MATERIALS AND METHODS: Transhepatic perforation of the left lobe of the
liver into the lesser curvature of the stomach was performed in 35 patients
with a presumed diagnosis of malignant obstructive jaundice. Jaundice was
found to be caused by a malignant stricture in 32 patients and a benign
stricture in three. Perforation was performed under fluoroscopic,
endoscopic, and laparoscopic guidance in 33 patients and without
laparoscopy in the other two. The hepaticogastric anastomosis was secured
with a gastrostomy tube; patency of the tract was maintained with placement
of a metallic stent. Kaplan-Meier analysis was used to evaluate survival,
anastomosis patency rate, and jaundice recurrence. RESULTS: Technical
success was achieved in all patients. Two (6%) patients had anastomotic
obstruction. The actuarial survival rate was 91%, 80%, 59%, and 26% at 1,
3, 6, and 12 months. The mean patency was 234 days +/- 252. The
jaundice-free rate among surviving patients was 100%, 96%, 93%, and 80% at
1, 3, 6, and 12 months. The reintervention rate was 14%. Late cholangitis
occurred in seven (20%) patients. CONCLUSION: This peripheral diversion
procedure appears to be safe and shows good long- term patency.
