Recent Advances in the Treatment of Obstructive Jaundice
In addition to the hazards incident to all surgery of the upper abdomen, operations on the biliary tract, performed in the presence of obstructive jaundice, are associated with special risks arising as the result of the biliary obstruction. The danger of secondary hemorrhage, of liver failure, and of the development of cholangeitis is always present in these operations. In the past year, however, certain advances in the prophylaxis and treatment of these complications have been made and we have good reason to believe that a striking reduction in the postoperative mortality rate of jaundiced patients will soon be observed.
The liver is invariably damaged by long-standing obstruction of the biliary tract. A marked hemorrhagic tendency is often present in patients with this condition and they are in poor condition to withstand a major surgical procedure. It is therefore not surprising to find the surgical mortality higher in patients with obstructive jaundice than in unjaundiced patients subjected to similar surgical procedures.
Hemorrhage is the greatest single cause of death, one-third of all postoperative deaths being attributable to this cause. Other causes of death in the order of their frequency are pneumonia, liver failure, cardiac failure, and a varied assortment of incidental complications (Table 1).
Secondary hemorrhage has been the most common complication following operations on patients with obstructive jaundice. In our experience hemorrhage has occurred most frequently on the first day, nine of the patients in this series of 100 cases having bled in the first 24 hours after operation. Three. . .