Surgical management of benign strictures of the biliary tract

Benign strictures of the biliary tract are difficult to treat surgical comp lications. Most biliary strictures result from injuries during cholecystect omies, and their initial management is a major determining factor of the lo ng-term outcome. Only surgeons well trained and experienced in their manage ment should treat this entity. The affected patients present various signs and symptoms depending on the time the lesion is detected, and the treatmen t modality largely depends on such timing. The success of surgical treatmen t with its attendant low morbidity and mortality makes it the preferred mod ality over transhepatic image-guided or endoscopic balloon dilatation, with or without the insertion of stents. Surgical treatment is based on three p rinciples: good exposure for internal drainage of the intrahepatic biliary tract, mucosa-to-mucosa anastomosis, and prevention of the risk of reoperat ion for recurrent stenosis. Roux-en-Y hepaticojejunostomy with a blind subc utaneous jejunal loop seems to comply with these three principles. Transana stomotic stents are not necessary. We have analyzed our experience from 198 8 to 1999 with 65 consecutive patients referred to us for biliary reconstru ction. We used the Roux-en-Roux-en-Y hepaticojejunostomy with a blind subcu taneous jejunal loop, performed by the same surgical group in all cases.