Biliary obstruction after gastrectomy for carcinoma of the stomach.

Extrahepatic biliary obstruction occurred in 34 patients after 1,300 gastrectomies performed for carcinoma of the stomach. Metastasis to the portal nodes caused mainly by distal gastric neoplasms is the most common cause of extrahepatic biliary obstruction. The syndrome of severe unrelenting bilirubinemia with abdominal aches and a palpable liver signifies extrahepatic biliary obstruction until proved otherwise and calls for early exploration. Palliative operation can prolong survival if properly performed. Selection of the proper procedure requires operative cholangiograms. Pancreatoduodenectomy is the most successful palliative procedure. Prevention of extrahepatic biliary obstruction requires a meticulous dissection of the portal pedicle during radical gastrectomy.