Recent experience with benign biliary strictures

Abstract

The management of benign biliary strictures continues to represent one of the most difficult problems in the practice of general surgery. Twenty-eight consecutive patients with benign strictures treated between 1972 and 1987 are reviewed in this report. Stricture etiology was iatrogenic in 13 patients, pancreatitic in 11, idiopathic in three, and traumatic in one. The authors performed 27 operations and three percutaneous transhepatic balloon dilatations in the treatment of these patients. Operative morbidity was 18 per cent; there were no operative deaths. Treatment was successful in 23 of 28 patients with a mean followup of four years, and four of the five patients with initially unsuccessful results have undergone successful remedial operations. Roux-en-Y biliary enteric diversion procedures have been most successful in these patients: seven patients with Roux-en-Y choledochojejunostomy without recurrence (mean followup of 62 months) and eight patients with Roux-en-Y hepaticojejunostomy with a success rate of 87.5 per cent (mean followup of 50 months). Two patients underwent three percutaneous transhepatic balloon dilatations; one has had a good result with short followup and the other failed on two occasions and has required a remedial operation. Benign biliary strictures have multiple etiologies. Therapeutic approaches, which now include nonoperative procedures, must be tailored to the needs of individual patients. The potential for recurrence is always present. Longterm followup remains essential in the management of patients with this disorder.