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Biliary strictures complicating pancreaticoduodenectomy
B J Ammori1, S Joseph, M Attia
1Department of Surgery, The Centre for Hepatobiliary Diseases, St. James's University Hospital, Leeds, UK.
Summary
Biliary-enteric strictures after pancreaticoduodenectomy can cause serious complications. Roux-en-Y hepaticojejunostomy is an effective surgical solution for managing these strictures and preventing secondary biliary cirrhosis.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Hepatology
Background:
- Biliary-enteric anastomotic strictures are a potential complication following pancreaticoduodenectomy.
- Ischaemia and reflux contribute to stricture formation, leading to bacterobilia and cholangitis.
Observation:
- Four patients presented with symptoms of biliary-enteric anastomotic stricture 1-12 years post-pancreaticoduodenectomy.
- Symptoms included recurrent cholangitis, obstructive jaundice, and liver abscess.
- Initial endoscopic and radiological interventions were unsuccessful.
Findings:
- Revision surgery using Roux-en-Y hepaticojejunostomy was required for all patients.
- Three patients remained asymptomatic post-operatively.
- One patient experienced re-stricture and developed secondary biliary cirrhosis, with liver transplantation under consideration.
Implications:
- Early diagnosis and prompt management of biliary-enteric strictures are crucial to prevent secondary biliary cirrhosis.
- Roux-en-Y hepaticojejunostomy offers a definitive treatment option for these strictures.
- Separate jejunal limbs for gastric and biliary anastomoses are recommended in Roux-en-Y hepaticojejunostomy.