SURGICAL-TREATMENT OF CICATRICIAL BILIARY STRICTURES

BACKGROUND/AIMS: Cicatricial biliary strictures are usually associated with high morbidity and mortality rates, frequently related to techni cal difficulties of their surgical repair, mainly in hilar lesions. In terference with bile duct blood supply during surgical attempts for co rrection is a major factor for unsuccessful results. The aim of this s tudy is to evaluate, after an extended follow-up period, the results o btained with a modified technique for surgical correction of cicatrici al biliary strictures. METHODOLOGY: The medical records of 57 patients surgically treated for cicatricial biliary strictures between January 1984 and July 1995 were reviewed and the immediate and long term resu lts retrospectively analyzed. Patients consisted of 46 females and II males. The average age was 43 years. The etiology of the biliary lesio n was: cholecystectomy alone (23); cholecystectomy with duct explorati on (8); T tube CBD drainage (6); Biliary-enteric anastomosis stricture (16); choledochoplasty (2) and trauma (2). In 28 cases (49.1%) the st ricture was located in the upper third of the bile duct, in 28 (49.1%) in the middle third and in one case (1.7%) it was low. All patients w ere submitted to longitudinal Roux-en-Y hepaticojejunostomy with mucos a apposition after dissection of the anterior aspect of the biliary tr act. No transanastomotic stents were used. RESULTS: Ten patients (17.5 %) presented II postoperative complications: biliary fistula (4), duod enal fistula (1), wound infection (5), and acute pancreatitis (1). Ave rage hospital stay was 11 days and there were no postoperative mortali ties. The follow-up study was possible in 54 patients and ranged from one to ten years, with an average of 2.9 years. Four patients of 28 (1 4%) with hilar lesions developed stricture recurrence and cholangitis episodes, whereas no patients bearing lesions below the biliary juncti on had such complications. CONCLUSION: Roux-en-Y hepaticojejunostomy w ith mucosa apposition without transanastomotic stent performed after m inimal dissection of the biliary duct, thus avoiding major interferenc e with the bile duct blood supply, is a safe and efficient method for the surgical repair of cicatricial biliary strictures. Using this tech nique excellent results can be obtained in the lesions below the bilia ry junction and acceptable results may be achieved in patients with hi lar lesions.