Management strategy for biliary stricture following laparoscopic cholecystectomy

Area of Science:

• Gastroenterology
• Surgical Innovation
• Biliary Tract Surgery

Background:

• Biliary strictures post-laparoscopic cholecystectomy (Lap-C) are a significant complication, often linked to vascular injuries.
• Management of these strictures presents ongoing challenges in surgical practice.

Purpose of the Study:

• To review institutional experience managing postoperative biliary strictures resulting from Lap-C.
• To evaluate the efficacy of different treatment modalities for these complex injuries.

Main Methods:

• Retrospective analysis of 14 consecutive patients with biliary strictures post-Lap-C (1997-2013).
• Evaluation of percutaneous transhepatic biliary drainage (PTBD) catheter dilatation and surgical interventions (e.g., hepaticojejunostomy, hemihepatectomy).

Main Results:

• PTBD catheter dilatation was successful in 5 of 8 patients initially, with one requiring repeat dilatation for recurrence.
• All 5 successfully treated patients maintained biliary patency over 72 months.
• Surgical management in 9 patients, including hepaticojejunostomy and right hemihepatectomy for complex cases, resulted in no major complications and long-term stricture resolution.

Conclusions:

• Percutaneous transhepatic biliary drainage (PTBD) catheter dilatation is recommended as the primary treatment for post-Lap-C biliary strictures.
• Right hemihepatectomy with cholangiojejunostomy is indicated for complicated injuries involving vascular damage.