BENIGN BILIARY STRICTURES - A REVIEW OF 21 YEARS OF EXPERIENCE

BACKGROUND: The treatment of patients with benign biliary strictures r emains a challenge for even the most skilled biliary surgeons, Within the wide range of causes of benign biliary strictures, iatrogenic lesi ons represent one of the major ones. Biliary reconstruction with Roux- en-Y anastomosis remains the treatment of choice for most cases of ben ign biliary strictures despite recent reports about endoscopic or perc utaneous management that have been quite encouraging. STUDY DESIGN: We retrospectively evaluated 194 patients who underwent surgery for beni gn biliary strictures over a 21-year period. The biliary strictures we re classified into eight different types according to their level. The surgical procedures had been tailored mainly to the site and the exte nt of the stricture as well as the overall status of the patient. RESU LTS: Postoperative mortality and morbidity rates were 2.6 percent and 20.1 percent, respectively, The results we obtained were 79.6 percent good, 8.9 pei cent moderate, and 11.5 percent unsatisfactory, The mean follow-up was 9.3 pears, In particular, hepaticojejunostomy performed in low- and mid-level strictures bad the best prognosis (good, 85.5 p ercent), while high and diffuse strictures had worse results (good; 70 percent), although with only hepaticojejunostomy according to Hepp-Co uinaud, this percentage increases to 81 pet-rent. CONCLUSIONS: Correct preoperative assessment of the site and extent of the biliary strictu re is important in the choice of the gold-standard surgical procedure, Hepaticojejunostomy and hepaticojejunostomy according to Hepp-Couinau d are the treatments of choice in most instances of benign biliary str ictures. Cholangiojejunostomy and hepatic resections are rarely indica ted and are performed mostly for highly complicated and intrahepatic s trictures. Endoscopic or percutaneous balloon dilatation should be res erved for high-risk patients.