Biliary strictures complicating pancreaticoduodenectomy

Background. Biliary-enteric anastomotic strictures may complicate pancreati coduodenectomy. Anastomotic ischaemia and reflux of gastric and enteric con tents with secondary bacterobilia and cholangitis may contribute. Methods. Four patients (3 females, 1 male) with a mean age of 50 yr (range 26-73 yr) presented 1-12 yr following pancreaticoduodenectomy with features suggestive of biliary-enteric anastomotic stricture formation. These inclu ded recurrent cholangitis, obstructive jaundice, and liver abscess. Diagnos is was confirmed by percutaneous or endoscopic cholangiography. Endoscopic and radiological management were unsuccessful, and revision surgery in the form of a Roux-en-Y hepaticojejunostomy was required. Results. Three patients remain asymptomatic 10-30 mo postoperatively. Jaund ice recurred at 15 mo in one patient owing to re-stricture formation and th e development of secondary biliary cirrhosis; a liver trans plantation is b eing considered. Conclusion. Early diagnosis and prompt management of biliary-enteric strict ure is essential if secondary biliary cirrhosis is to be avoided. Definitiv e therapy is best accomplished with a Roux-en-Y hepaticojejunostomy that pl aces the gastric and biliary anastomoses onto separate jejunal limbs.