Efficacy of the gallbladder for drainage in biliary obstruction: a comparison of malignant and benign disease.

To evaluate the efficacy of the gallbladder as an alternate drainage route in biliary obstruction, we reviewed the charts of 79 patients who underwent 80 cholecystoenterostomy (CCE) procedures at the UCLA Hospital during the period between 1955 and 1978. Among these procedures, 62 (77.5%) were done for malignant obstruction and 18 (22.5%) for benign obstruction; three patients with malignancy and one with benign disease were unavailable for follow-up. The CCE procedure failed in nine patients (11.8), five of 59 cases involving malignancy (8.5%), and four of 17 (23.5%) for benign disease. The 26-month cumulative patency was found to be 78.9% in malignant disease and 68.6% in benign disease. The combined failure rate of cholecystojejunostomy was 8.3%, compared to 30.8% with cholecystoduodenostomy. "Gross inflammation" was the only variable predictive of future CCE failure. The study suggests that CCE should be used primarily in terminal malignancy when a simple, short-term biliary bypass is desired.