Long-Term Outcomes Following Surgical Repair for Post-cholecystectomy Biliary Strictures.

INTRODUCTION: Bile duct injuries (BDIs) are a serious complication of cholecystectomy. Strictures that form after major injuries ultimately require surgical repair. This study aimed to analyse our experience with the surgical repair of post-cholecystectomy biliary strictures (PCBS). METHODS: Patients who underwent surgical repair for PCBS between January 2013 and March 2020 were retrospectively reviewed. The strictures were classified using the Bismuth system. Delayed repair with Roux-en-Y hepaticojejunostomy was performed using the Hepp-Couinaud technique. Outcomes were graded according to McDonald's criteria. Statistical analysis was performed to identify factors influencing the outcomes. RESULTS: Sixty-eight patients underwent repair for PCBS. Forty-five patients presented within one month and eight patients presented late after six months. Presenting symptoms were jaundice, external biliary fistula, biliomas, cholangitis and peritonitis. Portal hypertension was present in two patients. The median interval for definitive repair was 22 weeks. The median hospital stay was 9.5 days. Eighteen patients had postoperative complications. One patient had postoperative mortality due to uncorrectable coagulopathy. With a median follow-up of 54 months, successful outcomes were achieved in 61 (90%) patients. Four patients had anastomotic strictures evident at two, four, five and eight years after repair. Portal hypertension and postoperative complications were the variables associated with poor outcomes. CONCLUSION: BDIs following cholecystectomy are a devastating complication. Surgical repair for biliary strictures yields durable long-term outcomes with early identification and timely referral to a tertiary care centre where standardized techniques for biliary reconstruction are followed.

Still elusive: Developments in the accurate diagnosis of indeterminate biliary strictures.

Indeterminate biliary strictures pose a significant diagnostic dilemma for gastroenterologists. Despite advances in endoscopic techniques and instruments, it is difficult to differentiate between benign and malignant pathology. A positive histological diagnosis is always preferred prior to high risk hepatobiliary surgery, or to inform other types of therapy. Endoscopic retrograde cholangiopancreatography with brushings has low sensitivity and despite significant improvements in instruments there is still an unacceptably high false negative rate. Other methods such as endoscopic ultrasound and cholangioscopy have improved diagnostic quality. In this review we explore the techniques available to aid accurate diagnosis of indeterminate biliary strictures and obtain accurate histology to facilitate clinical management.

A Short Fully Covered Self-Expandable Metal Stent for Management of Benign Biliary Stricture Not Caused by Living-Donor Liver Transplantation.

Background: This study evaluated the effectiveness of short fully covered self-expanding metal stents (FCSEMS) with an anti-migration design in treating benign biliary strictures (BBS) not related to living donor liver transplantation (LDLT). Methods: A retrospective analysis was conducted on 75 patients who underwent FCSEMS insertion for BBS management. Stents were initially kept for 3 months and exchanged every 3 months until stricture resolution. Adverse events and stricture recurrence after FCSEMS removal were assessed during follow-up. Results: The study outcomes were technical success, stenosis resolution, and treatment failure. Technical success was 100%, with stricture resolution in 99% of patients. The mean onset time of BBS post-surgery was 4.4 years, with an average stent indwelling period of 5.5 months. Stricture recurrence occurred in 20% of patients, mostly approximately 18.8 months after stent removal. Early cholangitis and stent migration were noted in 3% and 4% of patients, respectively. Conclusions: This study concludes that short FCSEMS demonstrate high efficacy in the treatment of non-LDLT-related BBS, with a low incidence of interventions and complications. Although this is a single-center, retrospective study with a limited sample size, the findings provide preliminary evidence supporting the use of short FCSEMS as a primary treatment modality for BBS. To substantiate these findings, further research involving multicenter studies is recommended to provide additional validation and a broader perspective.

Anti-fibrotic and anti-stricture effects of biodegradable biliary stents braided with dexamethasone-impregnated sheath/core structured monofilaments.

Endoscopic biliary stent insertion has been widely used for the treatment of benign biliary stricture (BBS). Thus, the development of stent materials in the perspectives of structure, mechanical properties, and biocompatibility has been also studied. However, conventional metal and plastic stents have several disadvantages, such as repeated procedures to remove or exchange them, dislodgment, restenosis, biocompatibility, and poor mechanical properties. Sustainable effectiveness, attenuation and prevention of fibrosis, and biocompatibility are key factors for the clinical application of stents to BBS treatment. In addition, loading drugs could show synergistic effects with stents' own performance. We developed a dexamethasone-eluting biodegradable stent (DBS) consisting of a sheath/core structure with outstanding mechanical properties and sustained release of dexamethasone, which maintained its functions in a BBS duct over 12 weeks in a swine model. The insertion of our DBS not only expanded BBS areas but also healed secondary ulcers as a result of the attenuation of fibrosis. After 16 weeks from the insertion, BBS areas were totally improved, and the DBS was degraded and thoroughly disappeared without re-intervention for stent removal. Our DBS would be an effective clinical tool for non-vascular diseases. STATEMENT OF SIGNIFICANCE: This study describes the insertion of a drug-eluting biodegradable stent (DBS) into the bile duct. The sheath/core structure of DBS confers substantial durability and a sustained drug release profile. Drug released from the DBS exhibited anti-fibrotic effects without inflammatory responses in both in vitro and in vivo experiments. The DBS maintained its function over 12 weeks after insertion into the common bile duct, expanding benign biliary stricture (BBS) and reducing inflammation to heal secondary ulcers in a swine BBS model. After 16 weeks from the DBS insertion, the DBS thoroughly disappeared without re-intervention for stent removal, resulting in totally improved BBS areas. Our findings not only spotlight the understanding of the sheath/core structure of the biodegradable stent, but also pave the way for the further application for non-vascular diseases.

Refractory benign biliary stricture due to chronic pancreatitis in two patients treated using endoscopic ultrasound-guided choledochoduodenostomy fistula creation: case reports.

Benign biliary stricture (BBS) is a complication of chronic pancreatitis (CP). Despite endoscopic biliary stenting, some patients do not respond to treatment, and they experience recurrent cholangitis. We report two cases of CP with refractory BBS treated using endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) fistula creation. A 50-year-old woman and a 60-year-old man both presented with obstructive jaundice secondary to BBS due to alcoholic CP. They underwent repeated placement of a fully covered self-expandable metal stent for biliary strictures. However, the strictures persisted, causing repeated episodes of cholangitis. Therefore, an EUS-CDS was performed. The stents were eventually removed and the patients became stent-free. These fistulas have remained patent without cholangitis for more than 2.5 years. Fistula creation using EUS-CDS is an effective treatment option for BBS.

Management of Benign Biliary Stricture in Chronic Pancreatitis.

Endoscopic therapy is the first line of management for chronic pancreatitis (CP)-related benign biliary strictures. Multiple plastic stents (MPS) exchanged at regular intervals and temporary placement of fully covered self-expanding metal stents (FCSEMS) are preferred modalities of endotherapy. FCSEMS placement is non-inferior to MPS and requires fewer sessions of endoscopic retrograde cholangiopancreatography than MPS placement. The presence of head calcifications, severe CP, and length of stricture are predictors of failure or recurrence after endotherapy. Failure of endotherapy should be considered after 1 year when surgery should be considered.

A Comparison of the Efficacy of Plastic Stent Placement Above and Across the Sphincter of Oddi for Benign Biliary Hilar Stricture.

We investigated the efficacy and safety of endoscopic plastic stent (PS) placement for hilar benign biliary strictures (BBSs) and compared cases with PS placement above (inside stent, IS) and across (usual stent, US) the sphincter of Oddi. Patients who underwent initial endoscopic PS placement for hilar BBSs between August 2012 and December 2021 were retrospectively analyzed. Hilar BBSs in 88 patients were investigated. Clinical success was achieved in 81 of these cases (92.0%), including 38 patients in the IS group and 43 patients in the US group. Unexpected stent exchange (uSE) before the first scheduled PS exchange occurred in 18 cases (22.2%). The median time from first stent placement to uSE was 35 days. There was no significant difference in the rate and median time to uSE between the two groups. The rates of adverse events such as pancreatitis or cholangitis in the two groups did not significantly differ. However, the rate of difficult stent removal in the IS group (15.8%) was significantly higher than that in the US group (0%) (p=0.0019). US placement is preferable to IS placement for scheduled stent exchange, as it offers the same effectiveness and risk of adverse events with easier stent removal.

Percutaneous transhepatic endoscopic thulium laser vaporesection for management of severe and focal benign biliary strictures.

Background: Biliary lithiasis and strictures in the bile ducts have a causality. Dilation or stent placement is routinely used to treat strictures but fibrosis can lead to their recurrence. Thulium laser vaporesection with percutaneous transhepatic endoscopy is a novel therapeutic modal-ity for managing severe, focal benign biliary strictures (BBSs). There are few reports about this method of treating BBSs. Our study aimed to determine the safety and efficacy of this technique. Methods: Fifteen patients (six males and nine females) with BBSs underwent stricture ablation with thulium laser via percutaneous transhepatic endoscopy. The immediate and short-term technical success and complication rates were evaluated. Results: Biliary strictures appeared in segmental branches of two patients, in the left or right hepatic duct of twelve patients, and in the common bile duct of one patient. The immediate and short-term technical success rates of the thulium laser procedure were 100%. The lumen of the strictures measured 1-3 mm before the procedure and improved to 4-5 mm in six (40%) patients, 5-10 mm in five (33.3%) patients, and 10-15 mm in four (26.7%) patients after the procedure. No mortality and major procedure-related complications were observed. One patient experienced a minor complication (hemobilia). Conclusions: Percutaneous transhepatic endoscopic thulium laser ablation appears to be safe and effective for treating short-segment BBSs. However, further studies with large samples and long follow-up periods are necessary to fully determine the long-term outcomes of this technique.

Current status of endoscopic ultrasound-guided antegrade intervention for biliary diseases in patients with surgically altered anatomy.

Endoscopic management of biliary diseases in patients with surgically altered anatomy can be challenging because the altered anatomy makes it difficult to insert an endoscope into the biliary orifice. Even if insertion is feasible, the worse maneuverability of the endoscope and the restriction in available devices and techniques could complicate the procedure. Recently, endoscopic ultrasound-guided antegrade intervention (EUS-AG) has been reported as a useful management method for biliary diseases, especially in patients with surgically altered anatomy. In EUS-AG, the biliary disease is managed in an antegrade fashion through a temporal fistula created under EUS guidance between the intrahepatic biliary duct and upper intestine. In this article, we reviewed the current status of EUS-AG for each biliary diseases, malignant biliary obstruction, bile duct stones, and benign biliary stricture in patients with surgically altered anatomy.

Percutaneous transhepatic management of biliary strictures in patients with dysfunctioning plastic biliary endoprostheses.

BACKGROUND: To evaluate the safety and outcomes of percutaneous transhepatic management of dysfunctioning plastic biliary endoprostheses (PBE) in patients with benign/malign biliary strictures. METHODS: Twenty-nine patients (22 men, 7 women; mean age of 60.7 (range 33-88) years) diagnosed with dysfunctioning PBE were included. Percutaneous transhepatic biliary drainage and subsequent PBE dislodgment into the bowel were performed in all cases. Patient demographics, etiology of the biliary stricture, indication, technical success, complications, and clinical outcomes were gleaned from medical records. RESULTS: Seventeen patients had malignant strictures, while 12 patients had benign conditions. A total of 36 PBE (33 straight, 3 double-J) were treated. Six patients had more than one PBE. Successful dislodgement of the PBE was achieved in 28 (96.6%) of the cases. Monorail threading was performed in 8 cases while dislodgement by balloon friction was utilized in 21 patients. There was no statistical significance between benign and malignant biliary strictures regarding dislodgement duration (p = 0.080). No major complication was encountered. Thirteen minor complications in 10 patients including abdominal pain (n = 8) and mild hemobilia (n = 5) were observed and treated conservatively. Uneventful passage of the PBE was reported by all patients with technical success. DISCUSSION: Percutaneous transhepatic methods aid as a reasonable alternative in the treatment of benign and malignant biliary strictures in patients with dysfunctioning PBE when endoscopic approaches fail or are not eligible.

Percutaneous Transhepatic Treatment of Benign Bile Duct Strictures Using Retrievable Covered Stents: Long-Term Outcomes in 148 Patients.

OBJECTIVE: To investigate the long-term outcomes of percutaneous treatment of benign biliary strictures using temporary placement of a retrievable expanded polytetrafluoroethylene (PTFE) covered stent. MATERIALS AND METHODS: We retrospectively analyzed the outcomes of 148 patients (84 male and 64 female; age range, 11-92 years) who underwent percutaneous transhepatic placement and removal of a retrievable PTFE-covered stent for the treatment of benign biliary strictures between March 2007 and August 2019 through long-term follow-up. Ninety-two patients had treatment-naïve strictures and 56 had recurrent/refractory strictures. RESULTS: Stent placement was technically successful in all 148 patients. The mean indwelling period of the stent was 2.4 months (median period, 2.3 months; range, 0.2-7.7 months). Stent migration, either early or late, occurred in 28 (18.9%) patients. Clinical success, defined as resolution of stricture after completing stent placement and removal, was achieved in 94.2% (131 of 139 patients). The overall complication rate was 15.5% (23 of 148 patients). During the mean follow-up of 60.2 months (median period, 52.7 months; range, 1.6-146.1 months), 37 patients had a recurrence of clinically significant strictures at 0.5-124.5 months after removal of biliary stent and catheter (median, 16.1 months). The primary patency rates at 1, 3, 5, 7, and 10 years after removal of biliary stent and catheter were 88.2%, 70.0%, 66.2%, 60.5%, and 54.5%, respectively. In the multivariable Cox proportional hazard regression analysis, sex, age, underlying disease, relation to surgery, stricture type, biliary stones, history of previous treatment, and stricture site were not significantly associated with the primary patency. CONCLUSION: Long-term outcomes suggest that percutaneous treatment of benign biliary strictures using temporary placement of retrievable PTFE-covered stents may be a clinically effective method.

Efficacy of intraductal placement of nonflared fully-covered metal stent for refractory perihilar benign biliary strictures: A multicenter prospective study with long-term observation.

BACKGROUND: Endoscopic fully-covered self-expandable metal stents (FCSEMSs) are used to treat benign biliary strictures (BBSs); however, treatment for perihilar BBSs is technically challenging. The aim of this study was to evaluate the usefulness of an unflared FCSEMS designed for intraductal placement in patients with refractory perihilar BBS. METHODS: Twenty-two consecutive patients with perihilar BBS unresolved by endoscopic plastic stent placement at 13 tertiary medical centers were prospectively enrolled. The FCSEMS was placed above the papilla and removed after 4 months. The primary outcome was stricture resolution at 4 months, and the secondary outcomes were technical success, stent removal, adverse events, and recurrence. RESULTS: The technical success rate of intraductal FCSEMS placement was 100%, and plastic stent placement at contralateral or side branch was performed in 86% of patients. The rate of successful stent removal at 4 months was 100%, and stricture resolution was observed in 91% of patients. Stent migration or stent-induced de novo stricture did not occur in any patient. The stricture recurrence rate was 16%, and the median (interquartile range) follow-up duration was 2.8 (1.6-3.3) years. CONCLUSIONS: Intraductal placement of unflared FCSEMS is effective treatment for refractory perihilar BBS.

Covered Self-Expanding Metal Stents Versus Multiple Plastic Stents for Benign Biliary Strictures: An Updated Meta-Analysis of Randomized Controlled Trials.

Optimal endoscopic management of benign biliary strictures (BBS) has been a matter of debate with choice of stent remaining largely at the discretion of the endoscopist. In this systematic review and meta-analysis, we compared self-expanding metal stents with multiple plastic stents for benign biliary strictures. A comprehensive search of literature from 2000 till September 2021 was done of various databases for randomized controlled trials evaluating stent placement for benign biliary strictures. Our primary aim was to compare outcomes of endoscopic therapy for BBS using covered self-expandable metal stents (cSEMS) and multiple plastic stents (MPS) in terms of stricture resolution, number of ERCP sessions, recurrence of stricture, stent migration, and moderate-severe adverse events. Eight randomized controlled trials (534 patients) were included in the meta-analysis. cSEMS were comparable to MPS for stricture resolution (risk ratio {RR}: 1.0, 95% CI: 0.89-1.08, p=1.00), recurrence of stricture (RR: 0.73, 95% CI: 0.35-1.53, p=0.13), stent migration (RR: 0.90, 95% CI: 0.54-1.52, p=0.26), and moderate-severe adverse events (RR: 1.04, 95% CI: 0.67-1.61, p=0.19) with low to moderate heterogeneity among studies. cSEMS required fewer sessions of ERCP for stricture resolution (mean difference: 1.88, 95% CI: 0.91-2.85, p<0.00001) but with significant heterogeneity among studies. No difference in stricture resolution was seen in subgroup analysis between anastomotic strictures, chronic pancreatitis, or bile duct injury. cSEMS are comparable to MPS in patients with benign biliary strictures in terms of stricture resolution, recurrence, and adverse effects, needing fewer sessions of ERCP. Larger studies comparing cost-effectiveness of cSEMS and MPS in BBS are needed.

Role of ERCP in Benign Biliary Strictures.

Benign biliary strictures (BBS) can be associated with several causes, with postoperative and inflammatory strictures representing the most common ones. Endoscopy represents nowadays the first-line treatment in the management of BBS. Endoscopic balloon dilatation, plastic stents placement, fully covered metal stent placement, and magnetic compression anastomosis are the endoscopic techniques available for the treatment of BBS. The aim of this study is to perform a review of the literature to assess the role of endoscopy in the management of BBS and to evaluate the application of the different procedures in the different clinical settings.

Local application of triamcinolone acetonide-conjugated chitosan membrane to prevent benign biliary stricture.

Benign biliary stricture (BBS) is the proliferation of fibrous tissue of the biliary tract caused by the biliary operation, bile duct stones, cholangitis, trauma, and other etiologies due to scar contracture. Recent therapeutic strategies to suppress stenosis are insufficient. Here, we developed a sustained-release membrane (SM) of triamcinolone acetonide (TA) with N-succinyl hydroxypropyl chitosan (TASM) for inhibiting fibroblast proliferation in vitro and bile duct hyperplasia in the rabbit model for benign biliary stricture formation. The TASM were successfully placed in 45 of 50 rabbits. Evaluation of subcutaneous stimulation and acute liver injury confirms the safety of TASM in vivo. Compared to the control group, the TASM can significantly inhibit the proliferation of scar muscle fibroblasts in vitro. ELISA and immunofluorescence showed TASM could increase bFGF level and inhibit expression of TGFß1 and αSMA. Cholangiographic and histologic examinations demonstrated significantly decreased tissue hyperplasia in the TASM groups compared with the model group. The immunohistochemical staining showed that TASM could reduce the level of cytokine-induced scars and inhibit the proliferation of myofibroblasts. Taken together, the chitosan membrane chemically conjugated with TA can effectively inhibit the benign biliary stricture. Further clinical usage of this membrane may effectively reduce the occurrence of benign biliary stricture.

Endoscopic treatment of benign biliary stricture using different stents: a systematic review and meta-analysis.

INTRODUCTION: Biodegradable biliary stents (BDBSs), fully covered self-expanded metal stents (FCSEMSs) and multiple plastic stents (MPSs) were common stents in endoscopic treatment of benign biliary stricture (BBS). AIM: To evaluate the effectiveness of these 3 stents in BBS management. MATERIAL AND METHODS: The PubMed, Web of Science, Cochrane Library, and Wiley Library databases were searched for studies that provided data about BBS and stent therapy. RESULTS: We found that BDBSs were associated with the highest clinical success rate (0.76, 95% CI: 0.71-0.80), followed by MPSs (0.69, 95% CI: 0.63-0.74), and FCSEMSs (0.67, 95% CI: 0.63-0.71). BDBSs also had a relatively high probability of technical success, at 1.00 (95% CI: 1.00-1.00), superior to MPSs (0.95, 95% CI: 0.88-0.99) and FCSEMSs (0.90, 95% CI: 0.85-0.94). The treatment success rate for BDBSs (1.00, 95% CI: 1.00-1.00) was also higher than for MPSs (0.88, 95% CI: 0.72-0.98) and FCSMESs (0.82, 95% CI: 0.76-0.87). However, BDBSs had the highest stricture recurrence rate (0.21, 95% CI: 0.16-0.26), compared with FCSEMSs (0.11, 95% CI: 0.08-0.15) and MPSs (0.07, 95% CI: 0.03-0.13). CONCLUSIONS: Patients with BBS are likely to receive a satisfied outcome when treated with BDBSs.

Laparoscopic hepaticojejunostomy for benign biliary stricture: A case series of 16 patients at a tertiary care centre in India.

BACKGROUND: Gallstone disease is common in India, and since primary management involves surgery, it is one of the most commonly performed surgeries by a general surgeon either laparoscopically or open. There are various factors which are responsible for intra- and post-operative complications. These factors result in significant injuries which cause serious post-operative complications. Amongst them, benign biliary stricture is one such significant complication which is primarily managed by open surgery, but since advent of laparoscopy, there has been an increased interest in doing this repair laparoscopically. MATERIALS AND METHODS: This is a retrospective study of 16 patients having obstructive jaundice due to benign biliary stricture on magnetic resonance cholangiopancreatography who were operated consecutively over the past 10 years laparoscopically and underwent laparoscopic Roux-en-Y hepaticojejunostomy. RESULTS: All patients underwent laparoscopic hepaticojejunostomy. The mean surgical time was 280 min, and the mean blood loss was 176 ml. In the post-operative period, most of the patients were started orally after 48 h; four had atelectasis, eight had surgical site infection, none had seroma and two had bile leak. All post-operative complications responded to conservative management. CONCLUSION: The study demonstrates that laparoscopic surgery for benign biliary strictures is safe and feasible with acceptable results.

A Novel End-to-End Biliary-to-Biliary Anastomosis Technique for Iatrogenic Bile Duct Injury of Strasberg-Bismuth E1-4 Treatment: A Retrospective Study and in vivo Assessment.

Background: An iatrogenic bile duct injury (IBDI) is a severe complication that has a great impact on the physical and mental quality of life of the patients, especially for patients with postoperative benign biliary stricture. The effective measures for end-to-end biliary-to-biliary anastomosis intraoperative are essential to prevent the postoperative bile duct stricture, but also a challenge even to the most skilled biliary tract surgeon. Objective: A postoperative benign biliary stricture is an extremely intractable complication that occurs following IBDI. This study aimed to introduce a novel end-to-end biliary-to-biliary anastomosis technique named fish-mouth-shaped (FMS) end-to-end biliary-to-biliary reconstruction and determine the safety and effectiveness for preventing the postoperative benign biliary stricture in both rats and humans. Methods: In this study, 18 patients with biliary injury who underwent an FMS reconstruction procedure were retrospectively analyzed. Their general information, disease of the first hospitalization, operation method, and classification of bile duct injury (BDI) were collected. The postoperative complications were evaluated immediately perioperatively and the long-term complications were followed up at the later period of at least 5 years. An IBDI animal model using 18 male rats was developed for animal-based evaluations. A bile duct diathermy injury model was used to mimic BDI. The FMS group underwent an FMS reconstruction procedure while the control group underwent common end-to-end biliary-to-biliary anastomosis, a sham operation group was also established. The blood samples, liver, spleen, and common bile duct tissues were harvested for further assessments. Results: In the retrospective study, there was no postoperative mortality and no patient developed cholangitis during the 5-years postoperation follow-up. In the study of IBDI animal models, compared with the control group, the FMS reconstruction procedure reduced the occurrence of benign biliary stenosis, liver function damage, and jaundice. The blood tests as well as morphological and pathological observations revealed that rats in the FMS reconstruction group had a better recovery than those in the control group. Conclusions: An FMS reconstruction procedure is a safe and efficient BDI treatment method.

Indian College of Radiology and Imaging Evidence-Based Guidelines for Percutaneous Image-Guided Biliary Procedures.

Percutaneous biliary interventions are among the commonly performed nonvascular radiological interventions. Most common of these interventions is the percutaneous transhepatic biliary drainage for malignant biliary obstruction. Other biliary procedures performed include percutaneous cholecystostomy, biliary stenting, drainage for bile leaks, and various procedures like balloon dilatation, stenting, and large-bore catheter drainage for bilioenteric or post-transplant anastomotic strictures. Although these procedures are being performed for ages, no standard guidelines have been formulated. This article attempts at preparing guidelines for performing various percutaneous image-guided biliary procedures along with discussion on the published evidence in this field.

Percutaneous transhepatic cholangiography in the era of magnetic resonance cholangiopancreatography: A prospective comparative analysis in preoperative evaluation of benign biliary stricture.

BACKGROUND AND AIM: Accurate anatomical delineation is the key before definitive repair for benign biliary stricture (BBS). The role of percutaneous transhepatic cholangiography (PTC) as a road map is less studied in the era of magnetic resonance cholangiopancreatography (MRCP). METHODS: A prospective observational study, performed between July 2012 and December 2013. All patients of post-cholecystectomy BBS were evaluated with MRCP and PTC prior to definitive repair. Findings of MRCP and PTC were compared with intraoperative details. RESULTS: Thirty patients with BBS were included in the study. MRCP was performed in all but PTC was amenable in 28 of 30 (93.3%) patients. PTC was comparable to MRCP in diagnosing stricture type (96.4% vs 89.3%), intrahepatic stones (75% vs 75%), and biliary anomalies (95.6% vs 100%). Additionally, PTC revealed internal biliary fistula in 4 (85.7% vs 61.4%; P value 0.04). PTC-related minor complications were noted in 2 (7.1%) patients. CONCLUSION: PTC is comparable to MRCP in diagnosing the stricture type, intrahepatic biliary stones, and biliary anomalies. Though comparable to MRCP, the authors could not reveal any additional information that could change the course of management in BBS.