The current role of U tubes for benign and malignant biliary obstruction

• Published in: Annals of surgery Vol. 218; no. 5; pp. 621 - 629
• Main Authors: MILLIKAN, K. W, GLEASON, T. G, DEZIEL, D. J, DOOLAS, A
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott 01-11-1993
• Subjects: Adult; Aged; Aged, 80 and over; Anastomosis, Surgical; Biological and medical sciences; Cholestasis - etiology; Cholestasis - mortality; Cholestasis - surgery; Digestive System Neoplasms - complications; Diseases of the digestive system; Female; Follow-Up Studies; Humans; Male; Medical sciences; Middle Aged; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Retrospective Studies; Stents; Survival Rate; Treatment Outcome; Human; Biliary tract; Endoprosthesis; Instrumentation therapy; Digestive diseases; Technique; Biliary tract disease; Obstruction; Technical equipment
• ISSN: 0003-4932; 1528-1140
• DOI: 10.1097/00000658-199321850-00006

The recent experience with U tubes at Rush-Presbyterian-St. Lukes Medical Center was reviewed in order to assess their current role in hepatobiliary surgery.
Transhepatic intubation by a variety of methods has been used routinely for biliary decompression and inhibition of anastomotic stricture since the 1960s. U tubes were popularized in the early 1970s. However, little has been written about their use and efficacy in recent years. Because of the apparent benefits associated with the use of U tubes versus other stenting techniques, the authors performed this study.
The hospital and office charts of all patients who had U tubes placed between 1980 and 1992 were reviewed retrospectively. Between 1980 and 1992, U tubes were placed intraoperatively in 54 patients for biliary decompression and/or stenting. Twelve patients were operated on for benign causes of obstruction. Forty-two patients with malignant tumors underwent surgery for U tube placement in conjunction with or without tumor resection and anastomotic bypass.
There was a 0% operative mortality rate in the benign group. In six patients, the U tube played a major role in the long-term management of their disease processes. None of these patients has had restricture since removal of the tube. In the malignant group, the 30-day operative mortality rate was 12%. After 3 months, marked clinical improvement and complete biliary decompression were achieved, with mean bilirubin levels dropping from 14.0 mg/dL to 1.3 mg/dL. No patients in the malignant group required reoperation for recurrent biliary obstruction after U tube placement.
The use of U tubes is advocated for biliary decompression and/or anastomotic stenting in patients with benign stricture or resectable malignancy and in patients with nonresectable, malignant biliary obstruction for adequate palliation of intractable jaundice.