Abstract
Introduction: This study was done to find the factors leading to hepatic resections (HR) in post cholecystectomy benign biliary strictures (BBS) and their outcome. Methods: Retrospective analysis of a prospectively maintained database to identify patients who underwent HR in management of BBS. Pre-operative factors, intraoperative parameters, postoperative morbidity and follow-up details were noted. Outcomes were graded according to McDonald classification. Results: Six hundred forty eight patients of BBS were included. Eleven patients underwent HR (1.69%). Ten patients were of proximal BBS (type IV and V) while 1 patients was type III BBS. Three patients had stricture of previous repair (2 patients of hepaticojejunostomy and 1 of left hepaticoportoenterostomy). Associated vascular injury was present in 36.3% (4/11). Laparoscopic cholecystectomy (LC) was the primary surgery in 72.7% (8/11) (p < 0.001) patients. Median time from cholecystectomy to HR was 545 (226–1566) days. Proximal BBS (type IV and V, p < 0.001) and Atrophy-hypertrophy complex (AHC) (63.6%, 7/11patients) (p = 0.004, OR = 15.4, CI: 2.94–80.99) were predictive factors for HR in our study. Failed previous repair was also associated with HR (27%). Postoperative morbidity was 81.8% (9/11). Perioperative mortality occurred in 2 patients (18%). One patient expired in follow up after readmission for cholangitic abscess one year after surgery. Outcomes of HR with median follow up of 18 months were good with success rate of 63.6%. Conclusions: Hepatic resection has distinct role in select cases of complex BBS (type IV and V) with AHC with satisfactory long term results. AHC is a strong predictor for need for HR in BBS.
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