Surgical management of proximal benign biliary strictures

In 38 patients with high benign biliary stricture, who had previously undergone on average two unsuccessful operations for the condition, reoperation was performed. Direct mucosa-to mucosa anastomosis proximal to the stricture was done between a Roux-en-Y jejunal loop and a number of hepatic ducts in 20 patients (group A) or between a Roux-en-Y jejunal loop and the right and left hepatic ducts in 18 (group B). There was one death (group B). Complications resolved under conservative treatment. The long-term results were satisfactory. During follow-up averaging 6 years, no patient required further surgery for any reason related to the disease or its surgical treatment. Selective use of intrahepatic cholangiojejunostomy permits adequate biliary drainage of both liver lobes. Such drainage is essential for elimination of biliary stasis and to prevent postoperative cholangitis and recurrence of stricture.