Revision of Surgical Management of Malignant Obstructive Jaundice at Al-Bashir Teaching Hospital in Amman – Jordan
Kerbala Journal of Medicine,
2013, Volume 6, Issue 1, Pages 1480-1488
Abstractbackground: Malignant Obstructive Jaundice (MOJ) is caused by different diseases at
different levels and stages. Ideally, the best management is by early diagnosis and
treatment with multi-disciplinary approach that includes the full cooperation among
endoscopists, histopathologists, interventional radiologists, oncologists and surgeons.
Objective: This analytic retrospective study puts a light on the management of MOJ patients
the surgical department of Al-Bashir Teaching Hospital in Amman – Jordan. The gradual
changes in the surgical management were taken in consideration.
Method: The study included 98 patients who were treated surgically for MOJ during the
period from June 1999 to June 2006. The age of these patients ranged from 27 years to 85
years, with the mean age being 62 years. The data obtained includes the investigations done,
type, stage and level of MOJ, the type of surgical procedure and the postoperative
complications within 1 month.
Results: Most of the patients were males, 58 patients with a percentage of (59.18%). The
remaining 40 patients were females with a percentage of (40.82%). The types of surgical
management included Wipple's procedure for 16 patients with a percentage of (16.33%),
tumor resection for 3 patients with a percentage of (3.06%), bypass (palliative) procedures for
69 patients with a percentage of (70.41%) and the remaining 10 patients with a percentage of
10.20%) were found to be inoperable during diagnostic laparotomy. In general, the surgical
management had a morbidity of (18.37% - 18 patients) of which the mortality was (14.28% -
14 patients of these 18 morbid patients). Regarding investigation, U/S was performed for 62
patients only. It was positive in 30 patients with a percentage of (48.39%). Endoscopic
Retrograde Cholangiopancreatography (ERCP) was done in 34 patients, it was positive in 18
patients with a percentage of (52.94%). Abdominal CT scan was performed for 44 patients, it
was positive in 38 patients with a percentage of (86.36%). MRCP was done in 14 patients, it
was positive in 12 patients with a percentage of (85.71%).
Conclusion: MOJ is a disease occurring more frequently in middle age and elderly groups.
Most of the patients are presented lately, making the most common surgical procedure
performed for these patients being palliative (bypass) procedure. The use of sophisticated
investigations is shown to aid in the diagnosis and staging of MOJ.
Keywords: Malignant Obstructive Jaundice, Al-Bashir Teaching Hospital, Amman.
Key Words: Hepatitis C virus, Hemodialysis, Al-kindy teaching hospital
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