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External Bypass Operation for Biliary Tract Obstruction

Arch Surg. 1981;116(6):841. doi:10.1001/archsurg.1981.01380180085018.
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To the Editor.—Biliary obstruction secondary to nonresectable malignancy or inflammatory and iatrogenic stricture of the biliary tract is a serious condition. Decompression is essential to relieve obstruction, to allay symptoms, and to prolong life. Many procedures for decompression of the biliary tract have been reported, including bypass operations,1 percutaneous transhepatic drainage,2,3 and internal prostheses.4

I and my colleagues have been using an external biliary bypass that decompresses the biliary tree, bypasses the obstruction, and is easy to perform. At the time of laparotomy, a portion of the dilated biliary tract is exposed and opened proximal to the obstruction. A T-tube is inserted, with the long stem of the T-tube drawn to the exterior through a small stab wound. Similarly, the common duct, duodenum, or jejunum distal to the obstruction is selected and a T-tube is inserted. As with the proximal tube, the long vertical stem of


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