Management of benign high bile duct strictures following cholecystectomy

ABSTRACT

Biliary sepsis was controlled by proper antibiotics. Patients with subdiaphragmatic bilomas underwent ultrasonic guided drainage. PTC was the most valuable method of diagnosis in the majority of cases. It should be scheduled immediately prior to repair. Stricture repair using side to side hepaticojejunostomy was performed in 19 patients [16 type 3 and 3 type 4]. Bilateral jejunal mucosal graft was performed in 5 cases [all type 4], where exposure of the left duct system was difficult. There were no operative deaths. Follow up was done for a mean period of 4 years [range 3-6 years]. Among those managed by jejunal mucosal graft, two developed re-stenosis. This was 6 months and one year after repair. Both underwent percutaneous transhepatic balloon dilatation. One patient expired after an attack of hemobilia, while the second was successfully dilated with no evidence of re-stenosis for a follow-up period of 12 months. None of the patients underwent side to side hepaticojejunostomy developed re- stenosis. The overall success rate of side to side hepaticojejunostomy in dealing with high bile duct stricture was about 80%. In conclusion, the majority of high bile duct strictures can be managed with a high rate of success by side to side hepaticojejunostomy. In absence of liver disease and previous attempts of repair the long term results in these cases are excellent. Jejunal mucosal graft should be considered for patients in whom the biliary mucosa is inaccessible despite a deep and adequate dissection. Patients with re-stenosis after jejunal mucosal graft can be managed by percutaneous transhepatic balloon dilatation