Recurrent biliary stricture. Patterns of recurrence and outcome of surgical therapy

We analyzed the course of 50 consecutive patients with recurrent biliary stricture (at least one previous repair) to determine the pattern of recurrence and the outcome of additional treatment. The presenting manifestations included cholangitis in 40 percent of the patients, jaundice in 30 percent, and pain in 17 percent. Sixty-seven percent had become symptomatic within 2 years of their previous repair and 90 percent within 7 years. Ten (20 percent) patients were treated by end-to-end anastomosis of the bile duct, and 40 (80 percent) patients by bilioenteric anastomosis (hepaticojejunostomy in 32 patients and hepaticoduodenostomy in 8). Two patients (4 percent) died postoperatively. After repair of recurrent stricture, 38 (76 percent) patients had no further symptoms. In 11 (22 percent), another recurrence developed: 6 (55 percent) of the 11 did well after another operation and in 4 (36 percent), a third recurrence developed which was successfully treated by a fourth operation in 3 of the patients. Thus, two thirds of recurrent strictures were evident by 2 years and 90 percent by 7 years. The chance of another recurrence was about 25 percent after treatment of a first recurrence. There was no evidence that prolonged stenting contributed to a good result. Treatment of recurrent stricture should consist of anastomosis between the duct and the intestine, usually a hepaticojejunostomy.