Benign biliary strictures: an analytic review (1970 to 1984)

This report concerns 105 patients with benign biliary stricture operated on at the Cleveland Clinic from 1970 through 1984; in 102 patients the stricture was iatrogenic. The mean follow-up was 5 years (3 months to 13 years). Fifty-eight patients (55%) had undergone one or more attempts at correction of the stricture before referral to us; in 47 patients (45%) we performed the first corrective repair. Percutaneous transhepatic cholangiography was the optimal preoperative diagnostic procedure to define the site of stricture. Most patients had undergone a biliary-intestinal anastomosis, either choledochoduodenostomy, choledochojejunostomy, or hepatojejunostomy. Morbidity and mortality rates were 13% and 4%, respectively. The results of operative repair were correlated with the number of previous operations, site of stricture, type of operation, presence of a fistula, presence of cirrhosis, and length of T or Y tube stenting. The overall recurrence rate after a first operation was 18% and after a second operation was 26%. With continued attempts at repair, eventual success was achieved in 93% of patients.