Iatrogenic biliary stricture: presentation and management

Abstract

Repair of iatrogenic biliary stricture was carried out in 38 patients of whom five are now dead, three causally related. Thirty-one patients were followed up between August 1983 and March 1984 (mean time since repair 7.9 years). Fifty reparative operations were carried out, six patients first having a temporary end fistula performed. Cholangiography during cholecystectomy had been performed in only eight patients (21 per cent). All but one patient had gastroscopy and barium meal examination and the incidence of duodenal ulceration was 6.7 per cent and of oesophageal varices 5.6 per cent. Liver biopsies taken during the first reparative operation were normal in 5 per cent, obstructive in 65 per cent and cirrhotic in 30 per cent. Intra-operative cultures were mainly coliforms (66.7 per cent). Liver function tests were normal in 19 (61.3 per cent) but there was no correlation between abnormal values and clinical status. Twenty-nine patients (93.5 per cent) are now completely well. 99mTc HIDA scans, liver ultrasonography, intravenous cholangiography and BSP excretion were of limited value in planning further surgery. The most useful investigation before reoperation was transhepatic cholangiography.