modified long mire technique for biliary decompression in hilar cholangiocarcinoma (klatskin tumor) over 10 years experience of a single center

background: patients with malignant obstruction of the biliary tract suffer from progressive jaundice and purities, and if the obstruction is not relieved they will die from cholangitis, septicaemia or liver failure. the correct choice between many operative and non-operative procedures available to relive jaundice is not yet determined. unresectable disease (perihilar cholangiocarcinoma) found at the time of open exploration can be treated with a palliative surgical biliary bypass such as modified longmire technique. methods: eighteen (18) cases with unresectable hilar cholangiocarcinoma found at the operation underwent modified longmire technique for biliary decompression. results: the mean preoperative bilirubin level was 22 mg/dl. the post operative mean total bilirubin level was below 5mg/dl about 1 month after surgery. during the follow-up period, averaging 22 months (max 6 years), jaundice recurred only near the death of these patients. there was 1 in-hospital death, and the median survival was 18 months (maximum 6 years). the operation completely relieved the jaundice, and excellent palliation was achieved for more than 85% of the survival time. conclusion: we found this technique very effective to palliate patients mentioned above. key words: cholestatic jaundice; biliary decompression; modified long mire technique; hilar cholangiocarcinoma; klatskin tumor references 1. yeo. shackelford's surgery of the alimentary tract. 6th edition. 2007, vol ii chap104. 2. aljiffry m, walsh mj, molinari m. advances in diagnosis, treatment and palliation of cholangiocarcinoma: 1990-2009. world j gastroenterol. 2009 sep;15(34): 4240-62. 3. witzigmann h, lang h, lauer h. guidelines for palliative surgery of cholangiocarcinoma. hpb (oxford). 2008; 10(3): 154-60. 4. forsmo hm, horn a, viste a, hoem d, ovrebo k. survival and an overview of decision-making in patients with cholangiocarcinoma. hepatobiliary pancreat dis int. 2008aug;7(4): 412-7. 5. jonas s, benckert c, thelen a, lopez-hänninen e, rösch t, neuhaus p. radical surgery for hilar cholangiocarcinoma. eur j surg oncol. 2008 mar;34(3): 263-71. 6. ramos rubio e. radical surgery for hilar cholangiocarcinoma (klatskin tumor. cir esp. 2007 jul; 82(1): 11-15. 7. yasuji seyama, masatoshi makuuchi. current surgical treatment for bile duct cancer. world j gastroenterol. 2007 march 14; 13(10): 1505-15. 8. cameron jl, pitt ha, zinner mj, steven l.kaufman, joann coleman. management of proximal cholangiocarcinomas by surgical resection and radiotherapy. am j surg 1990; 159: 91–7. 9. hadjis ns, blenkharn ji, alexander n, benjamin is, blumjart lh. outcome of radical surgery in hilar cholangiocarcinoma. surgery 1990; 107: 597–604. 10. bismuth h, nakache r, diamond t. management strategies in resection for hilar cholangiocarcinoma. ann surg. 1992; 215: 31–8. 11. henry a. pitt charles j. yeo, william dooley. malignancies of the biliary tree current problems in surgery. 1995 jan; 32(1): 1-90. l.william traverso. the longmire i, ii, and iii operations. american journal of surgery. 2003 may, volume 185, issue 5