Post-operative bile duct strictures: Management of eight patients

ABSTRACT

Management of eight patients with benign bile duct stricture following cholecystectomy is discussed. Seven patients had been operated for gall stones while one had undergone cholecystectomy and repair of hepatic duct confluence after blunt abdominal trauma. Five patients had undergone multiple operations before referral to this hospital on admission, all the patients had abnormal liver function tests. Three patients had low serum albumin, 4 had a history of previous major infection and one patient had associated cirrhosis and portal hypertension. Five patients had an external biliary fistula. All the patients were operated upon 4 by mucosal graft operation [Bismuth type-IV], 3 by hepatico-jejunostomy by direct suture [Bismuth type-III and II] and one by choledocho-duodenostomy [Bismuth type-I]. There were no post-operative deaths in patients treated by hepaticojejunostomy. One of the 4 patients treated by mucosal apposition died in the immediate postoperative period; he had associated cirrhosis and portal hypertension. Six patients [75%] have a good result with a mean follow up of 3.5 years [range 2-8 years]. One patient has occasional attacks of jaundice and fever and persistently raised serum alkaline phosphatase. Factors influencing outcome were prolonged jaundice, site of stricture, number of previous attempts at stricture repair, associated cirrhosis and portal hypertension