Long-Term Outcomes Following Surgical Repair for Post-cholecystectomy Biliary Strictures

Area of Science:

• Gastroenterology
• Hepatobiliary Surgery
• Surgical Complications

Background:

• Bile duct injuries (BDIs) are a severe complication following cholecystectomy.
• Major BDIs necessitate surgical intervention for resulting biliary strictures.
• Post-cholecystectomy biliary strictures (PCBS) present a significant clinical challenge.

Purpose of the Study:

• To analyze the surgical outcomes of PCBS repair.
• To evaluate the effectiveness of the Hepp-Couinaud technique for biliary reconstruction.
• To identify factors influencing the success of PCBS repair.

Main Methods:

• Retrospective review of 68 patients undergoing PCBS repair (2013-2020).
• Bismuth classification of strictures; Roux-en-Y hepaticojejunostomy using Hepp-Couinaud technique.
• Outcome assessment via McDonald's criteria; statistical analysis of influencing factors.

Main Results:

• Successful outcomes in 90% (61/68) of patients after a median 54-month follow-up.
• Common presentations included jaundice, biliary fistula, biliomas, and cholangitis.
• Portal hypertension and postoperative complications were associated with poorer outcomes.

Conclusions:

• Surgical repair of PCBS offers durable long-term results.
• Timely referral to tertiary care centers is crucial for standardized biliary reconstruction.
• Effective management of BDIs requires prompt identification and specialized surgical expertise.