Postoperative Bile Duct Stricture

ABSTRACT

PURPOSE: Postoperative biliary stricture is rare, but can result in a dreadful condition unless it is properly treated. This study was undertaken to assess the clinical features of a postoperative biliary stricture and to evaluate the outcome of reconstructive methods according to the stricture locations and types. METHODS: From 1984 to 2001, 28 cases (M=16, F=12) of postoperative biliary stricture, which resulted from surgical injury and had subsequent reconstructive procedures performed in department of surgery of Seoul National University Hospital, during the period of 1984 to 2001, were retrospectively reviewed. Clinical features such as the symptom, type of surgery causing the stricture, laboratory finding, diagnostic modality, interval between the operation and symptoms and the type of stricture were reviewed and clinical outcomes of the reconstructive procedures were also analyzed. The mean follow-up period was 45.9 months (2~157). RESULTS: The most common symptoms of stricture was jaundice. 57.1% of patients showed symptoms within postoperative 6 months and 64.3% showed symptoms within 1 year. A cholecystectomy was most common surgical procedure that caused a postoperative biliary stricture. Bismuth type I was most common type of stricture (52.2%). Bilioenteric anastomosis (Roux-en Y hepaticojejunostomy) showed most excellent result among the many reconstructive methods. One case of an interventional balloon dilatation has maintained a good condition for 3 years after the procedure. The postoperative complications comprises bile leakage, a subphrenic abscess, an incisional hernia, am intrahepatic duct stone, recurrent pyogenic cholangitis. There were 2 cases of postoperative mortality. CONCLUSION: Roux-en Y hepaticojejunostomy is considered to the procedure of choice for a postoperative biliary stricture. An interventional balloon dilatation is expected to show good result with more cases and adequate indications.