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Current management of benign bile duct strictures
K D Lillemoe1, H A Pitt, J L Cameron
1Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Advances in Surgery
|January 1, 1992
Summary
Benign bile duct strictures, often from cholecystectomy, require careful management. Surgical reconstruction with biliary-enteric anastomosis and stenting shows promise over nonoperative dilatation for complex cases.
Area of Science:
- Hepatobiliary Surgery
- Gastroenterology
Background:
- Benign bile duct strictures are challenging surgical problems, frequently arising after cholecystectomy.
- Patients may present with biliary leaks, jaundice, or cholangitis, necessitating prompt diagnosis and management.
Purpose of the Study:
- To review current management strategies for benign bile duct strictures.
- To compare operative versus nonoperative approaches, emphasizing surgical reconstruction techniques.
Main Methods:
- Delineation of proximal biliary anatomy is the critical first step.
- Management options include operative biliary reconstruction (e.g., Roux-en-Y biliary-enteric anastomosis) and nonoperative balloon dilatation (percutaneous or endoscopic).
- Long-term biliary stenting with Silastic stents is favored in reconstructive surgery.
Main Results:
- Retrospective data suggest surgical reconstruction with stenting is superior to nonoperative dilatation.
- Primary sclerosing cholangitis requires specific management, including resection and stenting or liver transplantation for advanced disease.
- Other causes like pancreatitis or Crohn's disease may be managed with choledochoenterostomy without long-term stenting.
Conclusions:
- Surgical reconstruction, particularly biliary-enteric anastomosis with long-term stenting, offers favorable outcomes for benign bile duct strictures.
- Management must be tailored to the specific etiology and extent of the stricture, with liver transplantation as an option for severe intrahepatic disease or cirrhosis.