Duodenal and biliary bypass surgery
Bypass surgery bypasses a biliary or duodenal obstruction, making a new way for bile to flow to the intestines, and for food to flow out of the stomach into the duodenum (1). Patients may have double bypass surgery for a blocked duodenum and blocked bile duct at the same time.
Duodenal bypass surgery may be offered (as opposed to stents or no treatment) to patients with a more favourable prognosis and good performance status. Biliary stent is preferred for a biliary blockage (outside of a failed operation, when bypass surgery will be performed if necessary).
Bypass surgery during an operation to remove the cancer
Sometimes patients may go into surgery with the intention of removing the cancer but then the surgeon finds that it is not possible to remove the cancer (1). This may happen because:
- The cancer has spread to the liver
- The cancer has spread to the peritoneum (lining of the abdomen)
- The cancer has grown into or around nearby blood vessels
If this happens, the surgeon may do bypass surgery to help control symptoms if the cancer has blocked the duodenum or bile duct or to prevent a future blockage (1,2). Chemotherapy should also be offered to help control the cancer.
Bypass surgery for duodenal obstruction
Gastric outlet obstruction occurs when the cancer has blocked the duodenum, stopping food passing out of the stomach. The operation to bypass a blocked duodeum is called a gastrojejunostomy (2). The surgeon will connect the stomach to the small intestine (3).
NICE guidelines recommend that bypass surgery should be considered rather than a duodenal stent if the patient has a more favourable prognosis (1,2) and if the person is fit enough to tolerate it.
Bypass surgery may also be considered to prevent the cancer from blocking the duodenum in the future if the cancer cannot be removed by surgery.
Bypass surgery for biliary obstruction
The operation to bypass a blocked bile duct is called a choledochojejunostomy or hepaticojejunostomy (2). The surgeon will cut the bile duct above the blockage and connect it to the small intestine (4).
NICE guidelines recommend offering resectional surgery rather than preoperative biliary drainage to people who: have operable pancreatic cancer and obstructive jaundice (subject to how high the bilirubin is / how jaundice they are), and are well enough for the procedure, and are not enrolled in a clinical trial that requires preoperative biliary drainage (1).
If patients have inoperable cancer and their bile duct is blocked, they will usually have a stent put in rather than bypass surgery (1).
A stent is a better option than bypass surgery if the patient is weak and would not be able to tolerate surgery, and in some cases, no treatment may be the best option if the patient has a poor performance status.
Advantages of bypass surgery
- The surgery bypasses the blockage and should help symptoms (2,5)
- It may be an option if a stent is not suitable
- Avoids the problem of stents getting blocked
- Longer lasting way to treat symptoms
Disadvantages of bypass surgery
As it is a major operation, there are risks:
- As with all surgery, there is a risk of getting a chest infection or deep vein thrombosis (DVT) or pulmonary embolism (PE).
- Problems after surgery are more likely than with stents (5). For example, wounds may get infected.
- Patients will need to stay in hospital for a few days after bypass surgery, and it may take a few months to fully recover.
- There is a small risk of bleeding during the operation and a blood transfusion to replace the blood lost may be needed.
- There are risks to having a general anaesthetic but an allergic reaction to the anaesthetic is very rare.
- As with any surgery, there is a small risk of dying.
- There may be side effects, but there are usually ways to manage these.
Information for your patients
- Fact sheet: Bypass surgery if you have pancreatic cancer
- Web information: Bypass surgery if you have pancreatic cancer – Pancreatic Cancer UK