Portal Hypertension and Post-Cholecystectomy Biliary Strictures

Abstract

One hundred and one patients with post-cholecystectomy biliary strictures have been studied. On admission, 13 had a diagnosis of portal hypertension made on examination or following endoscopy and/or selective coeliac angiography. All patients had histological examination of the liver. Twelve were shown to have liver fibrosis and 1 had cirrhosis with a possible alcoholic component. The development of portal hypertension was influenced by a history of previous major infection, previous surgery and the distance of the stricture from the confluence of the right and left main hepatic ducts. Of the 101 patients, 7 were treated conservatively and 94 surgically, including 12 with portal hypertension. The operative mortality for patients treated by stricture repair alone was 2.4% (2 patients) and the overall mortality for the series was 10% (10 patients). Of the 13 patients with portal hypertension, 6 died overall (46%) compared with 4 of the remaining 88 (4.5%). The presence of portal hypertension had a major influence on outcome in this series and is most likely to develop in patients with a long duration of illness who have had multiple previous attempts at stricture repair, hilar strictures and a history of serious infection.