BENIGN BILIARY STRICTURES - REPAIR AND OUTCOME WITH A CONTEMPORARY APPROACH

Background. The Hepp-Couinaud technique is an innovative approach for repair of proximal biliary strictures. We have used this method select ively for bile duct reconstruction since 1982. Our aim was to analyze our experience with the surgical repair of benign biliary strictures i n the decade since the Hepp-Couinaud technique has become an integral component of our surgical management strategy. Methods. Seventy-two pa tients undergoing surgical repair of benign biliary structure between 1983 and 1992 were reviewed retrospectively. A grading system an clini cal symptoms, results of liver function studies, and need for reinterv ention was used to assess outcome. Results. For the 27 patients with n oniatrogenic strictures, followed up a mean of 3.9 years, excellent or good results (grade A or B) were obtained in 88.9%. For the 45 patien ts with iatrogenic strictures, followed up a mean of 4.6 years, 86.7% were categorized as grade A or B. The cumulative probability of anasto motic failure was significantly less for the 21 patients in whom the H epp-Couinaud method was used when compared with the 24 patients in who m it was not (p = 0.032). Outcome was not influenced by age, time dela y from injury to reconstruction, preoperative scenting, the number of previous repairs, or the duration of postoperative stenting Conclusion s. Surgical reconstruction affords excellent or good results for the v ast majority of patients with benign biliary strictures. For proximal iatrogenic strictures superior anastomotic durability is achieved with the Hepp-Couinaud technique