Management of extra hepatic biliary obstruction, in a rural tertiary care hospital India


  • Divyanshu Joshi Department Of General Surgery, SMC, Meerut, India
  • Y. P. Monga Department Of General Surgery, SMC, Meerut, India
  • Shashank Mishra Department Of General Surgery, SMC, Meerut, India
  • Rani Bansal Department of Pathology, SMC, Meerut, India
  • Sachin Agrawal Department of Radio Diagnosis, SMC, Meerut, India





Background: Extra hepatic biliary obstruction (EHBO) is not a rare surgical problem; our experience in managing 36 patients over a period of two years at a tertiary care hospital in a rural setting in India. The objective was to study the etiology and clinical presentation of patients with EHBO, role of various investigative modalities and management strategies in these patients and their outcome.

Methods: This was a prospective study conducted between September 2018 to August 2020 in the department of surgery in tertiary care center Subharti medical college (SMC) Meerut. Data was taken in a pre-formed performa and the results were tabulated and analyzed (descriptive analysis).

Results: Out of 36 patients, 2 (5.5%) patients underwent choledochoduodenostomy, 1 (2.7%) exploratory laparotomy with CBD exploration with t tube drainage, 1 (2.7%) ERCP with pigtail drainage; 17(47.2%) ERCP (endoscopic retrograde cholangiopancreatography) followed by cholecystectomy, 1 (2.7%) open cholecystectomy with t tube drainage, 4 (11.1%) ERCP alone, 2 (5.5%) hepaticojejunostomy, 1 (2.7%) ERCP followed by diverticulectomy, 2 (5.5%) PTBD (percutaneous transhepatic biliary drainage) followed by a triple bypass surgery, 2 (5.5%) PTBD, 1 (2.7%) pylorus preserving pancreaticoduodenectomy, 1 (2.7%) ERCP with sphincterotomy, 1 (2.7%) PTBD followed by whipples procedure. Patients were followed up and 5 (13.8%) patients had recurrence of the disease.

Conclusions: EHBO is a hepatobiliary surgical condition caused by both neoplastic and non-neoplastic etiology. Benign pathologies common in younger patients whereas neoplastic conditions in older age. Ultrasonography is the most common investigative modality followed by ERCP with PTBD/ENBD playing an important role in decompression of biliary obstruction as a palliative measure in advanced malignancies.


Gelan EA, Abdlhadi M, Bekele M, Tsehay A, Lemmu B. A retrospective analysis of etiological spectrum, clinical presentation, treatment and outcome of extra hepatic biliary tree obstruction at a tertiary teaching hospital in Addis Ababa, Ethiopia. Ethiopian Med J. 2019;57(2):125-32.

Assi AN, Hassan AJ, Ali KN. The etiological spectrum of obstructive jaundice and role of ERCP In Thi-Qar governorate. Iosr J Pharm. 2013;3(3):26-30.

Abdullah AB, Al-Faddagh ZA. Obstructive jaundice in Basrah, Iraq. Bas J Surg. 2011;17(2):45-57.

Sun J, Liu G, Yuan Y, He Y, Liu ZS. Operable severe obstructive jaundice: How should we use preoperative biliary drainage? S Afr J Surg. 2013;51(4):127-30.

Gowda S, Desai PB, Hull VV, Math AAK, Vernekar SN, Kulkarni SS. A review on laboratory liver function tests. Pan Afr Med J. 2009;3:17.

Hameed AM, Wong G, Laurence JM, Lam VWT, Pleass HC, Hawthorne WJ. A systematic review and meta-analysis of cold in situ perfusion and preservation for pancreas transplantation. HPB (Oxford). 2017;19(11):933-43.

Vendemiale G, Grattagliano I, Lupo L, Memeo V, Altomare E. Hepatic oxidative alterations in patients with extra-hepatic cholestasis. Effect ofsurgical drainage. J Hepatol. 2002;37(5):601-5.

Harbin WP, Mueller PR, Ferrucci JT. Transhepatic cholangiography: complicatons and use patterns of the fine-needle technique: a multi-institutional survey. Radiology. 1980;135(1):15-22.

Zimmon DS, Falkenstein DB, Riccobono C, Aaron B. Complications of endoscopic retrograde cholangiopancreatography. Analysis of 300 consecutive cases. Gastroenterology. 1975;69(2):303-9.

Fulcher AS, Turner MA, Capps GW, Zfass AM, Baker KM. Half-fourier RARE MR cholangiopancreatography: experience in 300 subjects. Radiology. 1998;207(1):21-32.

Miguel ES, Thomas MK, Martin HP, Erik JAR, Huug O, Dirk JAG. Meta-analysis on the Efficacy of preoperative biliary drainage for tumors causing obstructive jaundice. Ann. Surg. 2002;236(1):17-27.

Madhu MP, Agrawal V, Soni A, Pokharna RK, Nijhawan S, Sharma G, et al. Etiological spectrum of extra hepatic biliary obstructive (EHBO) at a tertiary care centre in Northern India. Tropic Gastroenterol. 2015.






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