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Postcholecystectomy benign biliary strictures - long-term results
S S Sikora1, B Pottakkat, G Srikanth
1Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India. sadiqsss@rediffmail.com
Insights
Surgical repair of benign biliary strictures after cholecystectomy yields excellent long-term outcomes. Dedicated units and meticulous surgical technique minimize morbidity and mortality for these complex bile duct injuries.
Area of Science:
- Gastroenterology
- Hepatobiliary Surgery
- Surgical Complications
Background:
- Cholecystectomy is a common surgical procedure.
- Bile duct injury is a serious complication leading to long-term morbidity.
Purpose of the Study:
- To analyze the outcomes of surgical repair for postcholecystectomy benign biliary strictures.
- To evaluate the safety and efficacy of Roux-en-Y hepaticojejunostomy in managing these strictures.
Main Methods:
- Prospective analysis of 300 patients with benign biliary strictures managed between 1989 and 2004.
- Data collected included demographics, clinical presentation, and surgical repair outcomes.
- Surgical repair predominantly involved Roux-en-Y hepaticojejunostomy.
Main Results:
- The majority of patients (97%) underwent Roux-en-Y hepaticojejunostomy repair.
- Postoperative morbidity was observed in 33.3% of patients, with a mortality rate of 1.3%.
- Long-term follow-up (mean 9.5 years) showed excellent outcomes in 90% of patients, with only 5.4% experiencing poor outcomes.
Conclusions:
- Excellent long-term outcomes are achievable for benign biliary strictures.
- Management in dedicated units with adherence to surgical principles is crucial.
- Meticulous surgical technique can minimize morbidity and mortality associated with bile duct injuries.
Background:
Cholecystectomy is the most frequently performed general surgical procedure. Bile duct injury is a dreaded complication and is associated with serious long-term morbidity.
Patients And Methods:
Three hundred patients with postcholecystectomy benign biliary strictures were managed from January 1989 to February 2004 at a tertiary care unit in northern India. Demographic data, clinical presentation, and immediate- and long-term results of surgical repair are analyzed from a prospective database.
Results:
The time from cholecystectomy (open, n = 262; laparoscopic, n = 38) to stricture repair ranged from 0.2 to 360 (median 7) months. Thirty-six patients (12%) had prior stricture repair. Bismuth classification of the bile duct strictures was 32 type I, 113 type II, 126 type III, 18 type IV, and 11 type V. Two hundred and ninety-two patients (97%) underwent repair by a Roux-en-Y hepaticojejunostomy. One hundred patients (33.3%) had postoperative morbidity following stricture repair. Four patients (1.3%) died during the postoperative period. Of the 149 patients with a minimum available follow-up period of 5 years (mean 9.5, median 9.4 years; range 5-15.4 years), 134 (90%) had an excellent outcome (grade A, n = 122; grade B, n = 12); only 8 patients (5.4%) had a poor outcome.
Conclusion:
Excellent long-term outcomes with minimal morbidity and mortality can be achieved in the subgroup of benign biliary strictures managed in dedicated units with meticulous attention to the central tenets of biliary surgery.
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