Hepatectomy for complex iatrogenic biliary strictures; 18 year experience from a tertiary centre from North India.

Abstract

Introduction: Benign biliary strictures secondary to iatrogenic injuries, involving the primary confluence pose a difficult surgical challenge, healthy duct is not available for reconstruction. The aim of this study is to report our experience of this group of patients treated with hepatectomy. Method: From January 2001 to December 2018, 572 patients of Biliary strictures were treated at our institute with 12 of them undergoing hepatectomy. All but one patient had complex stricture ( isolated segmental stricture), with atrophy hypertrophy complex and recurrent cholangitis were seen in two-thirds of patients and hepatolithiasis in one third. Patients underwent a mean of 2.25 (range 1-7) interventional, endoscopic or surgical procedures after the index surgery prior to hepatectomy. Result: 11 patients underwent right hepatectomy and one patient underwent left lateral segmentectomy. The decision for hepatectomy had to be made intraoperatively in 6 patients. There were two postoperative mortalities - one patient had DIC, another patient, who had a complex presentation with biliocolonic and bronchobiliary fistulae, had a parenchymal bleed. Major morbidity was seen in 58% - pleural effusion in 42%, bile leak in 25%, hepatic decompensation in 12%. With a mean duration of follow up at 7 years 2 months (range 27 - 189 months), excellent or good results were seen in 8 patients( 78%). Conclusion: Liver resection is an optimal treatment option before the development of secondary biliary cirrhosis. It is not only an option in a select group of patients with failed repairs but also as an SOS option intraoperatively when ducts are difficult to find. Although it has high morbidity, long term results are fair to excellent.