[Intubation of proximal biliary stenoses using a new surgical endoprosthesis]

Thirty patients with high biliary tract strictures were treated by a new surgical endoprosthesis, the tolerance of which has been tested experimentally. It is flexible, radiopaque and incompressible with spurs which prevent migration. Following choledochotomy, the endoprosthesis is positioned surgically above the sphincter of Oddi, thereby avoiding ascending cholangitis. Twenty-nine cases presented with neoplastic compression by an inoperable cancer and one case had an early postoperative stricture with loss of substance after right hepatectomy for hepatic metastases. The 29 cancers included 13 gallbladder cancers, 11 cholangiocarcinomas, 10 of which were hilar, and 5 metastatic compressions due to gastrointestinal adenocarcinomas. In three cases, there was loss of substance of biliary tract after intubation. The operative mortality was 3.3% (one pulmonary complication). Resolution of jaundice was obtained in all but 2 cases and pruritus always resolved. The mean survival of the patients with cholangiocarcinoma was 12.2 months while that of patients with gallbladder cancer was 6.33 months with indices of satisfaction, calculated by Bismuth's method, varying between 71% (gallbladder cancer) and 93.5% (hilar cholangiocarcinoma). The patient operated for benign stricture secondary to a hepatectomy scar for metastases died from lung metastases without jaundice after 48 months. The only late complications were 2 cases of cholangitis treated medically, one of which was due to obstruction of the endoprosthesis at the 13th month. The authors conclude that this new type of surgical endoprosthesis constitutes an alternative in the palliative treatment of neoplastic hilar compressions.