Strictures of the terminal bile duct--who profits from the surgery?

Elucidation of the etiology of terminal bile duct strictures is oftentimes challenging. In choosing the optimal treatment method, a multidisciplinary approach is necessary.

To demonstrate the advantages and indications of surgical management, 153 patients with terminal bile duct strictures were retrospectively analysed. All patients had been treated during a period of eight years (1st January 1995 - 31st December 2002) in same department. The principal datas studied were surgical morbidity, thirty-days' mortality rates and recurrence of jaundice.

During a period of eight years, 153 patients (100%) underwent laparotomy. Radical surgery (duodenopancreatectomy) was performed in 79 patients (51.6%), while 74 others (48.4%) benefited from bypass procedures. Postoperative morbidity reached 13.1%; nine patients (5.9%) died within the thirty days of surgery. Recurrence of jaundice was observed in three patients (1.9%).

Surgical management of terminal bile duct strictures is indicated in most patients with benign strictures, strictures of unknown origin and with malignant strictures, where the patients are in a reasonably satisfactory clinical condition. The surgical approach provides the potential advantage to obtain a definite histological diagnosiscare and to remove the tumour in many patients. Patients with non resectable tumours could benefit from bypass procedures ensuring long-term and effective drainage of the bile.