Liver Resection Under Ischemia: Inflow Occlusion or Total Hepatic Isolation

203 surgery group. The procedure-related complications (28% and 32%, respectively) and 30 day mortality (8% and 20%) were similar. Although the initial hospital stay was significantly shorter in the stented group (18 vs 24 days), this difference was not maintained when readmissions for obstructed endoprostheses and duodenal obstruction were also considered. Another study by Dowsett et al. included 127 patients with unresectable malignancy obstructing the distalbile duct2. Sixty-five patients were treated via endoscopic stenting and 62 had surgical palliation. Successful biliary drainage was achieved in 94% of patients, with the 30 day mortality being 6% after endoscopy and 15% after surgery. However, recurrent jaundice (17% vs 3%) and late duodenal obstruction (14% vs 3%) were seen more commonly in the endoprosthesis group. Unfortunately, no prospective randomized studies have compared surgical to nonsurgical palliation ofhilar cholanginocarcinoma or more proximal biliary obstruction , and therefore data applicable to this situation are lacking. In conclusion, the management of patients with obstructive jaundice from either benign or malignant processes no longer resides solely within the hands of surgeons. A multidisciplinary approach to such a problems is currently indicated, with some patients being best treated by endoscopic or percutaneous techniques, others by surgical techniques, and still others using a multidisciplinary approach. Operatively placed transhepatic stents continue to play an important role in the management of these patients. So do the procedures performed by our talented endoscopists and interven-tional radiologists. The role of U tube palliative treatment in high bile duct carcinoma. duct tumors. Surgical management with silastic transhepatic biliary stents. (1992) Transhepatic biliary stents in high benign and malignant biliary tract obstructions. In: Mechanisms of major biliary injury during laparoscopic cholecystectomy. Spectrum and management of major complications of laparoscopic cholecystectomy. Am. Treatment of proximal biliary tract carcinoma: An overview of techniques and results. Surgery, 97, 251-262. (1990) Management of proximal cholangiocarcinomas by surgical resection and radiotherapy. Am. Randomized trial of self-expanding metal stents versus polyethylene stents for distal malignant biliary obstruction. Prospective controlled trial of transhepatic biliary endopros-thesis versus bypass surgery for incurable carcinoma of the head of the pancreas. Lancet, 1, 69-71. Malignant obstructive jaundice: A prospective randomized trial of bypass surgery versus endoscopic stenting. Gastro-enterology, 96, A 128.