Biliary enteric anastomosis versus endoscopic biliary stenting in treatment of benign biliary strictures

ABSTRACT

Surgical repair has been the traditional method of treatment for benign biliary strictures giving good long-term results in most cases. Advances in interventional endoscopic techniques have established the important role of endoscopy in management of such conditions.This study compared the effectiveness of endoscopic and surgical managements of benign postoperative biliary strictures.Over the last 6 years, 31 patients were seen with diagnosis of benign biliary strictures. 21 patients had postcholecystectomy strictures and were included in this study Eleven of these patients were managed endoscopically with insertion of biliary stents and ten patients were treated surgically either by hepaticojejunostomy orcholedochojejunostomy. The mean follow up period was 28 + 11.5 months in the endoscopy group and 29 +/- 12.1 months in the surgery group. The results in both groups were evaluated by the short-term outcome involving morbidity, mortality and hospital stay, and the long-term outcome.Complications were more frequent in patients managed endoscopically than patients treated surgically[5 vs 2; p 0.21]. Duration of hospital stay was significantly longer in the surgery group than the endoscopy group [11.2 days vs 4.1 days; P<0.001]; even after considering repeated hospitalization for complications [11.4 daysvs 5.9 days; PO.001]. There was no hospital mortality in both groups. Surgery showed good long-term results in 70% of patients, fair results that required medical treatment in 20% of patients and poor results in one patient [10%]. Endoscopic management had good long-term results in 64% of patients, fair results in 18% of patients and poor results in 18% of patients. Overall, three patients [14%] showed poor results and were subjected to surgery for anastomotic stricture [one patient], restenosis after stent removal [another patient], or complete metal stent obstruction [the third patient].In conclusion, endoscopic biliary Stenting using plastic endoprosthesis in patients with benign biliary strictures has obtained good results and tolerable complications nearly equal to surgery. Endoscopic management is advised to be the first approach in such patients, and hepaticojejunostomy is indicated if endoscopic procedures fail or in case of recurrent stenosis. The use of metallic stents in benign biliary strictures has yet to be evaluated