Abstract
BackgroundIatrogenic biliary stricture (IBS) is a disastrous complication of cholecystectomy. Although the endoscopic treatments are well accepted as initial attempts for IBS, surgical hepaticojejunostomy (HJ) is often necessary for a considerable proportion of patients. However, the anastomotic stricture after HJ also occurs.MethodsIn the present study, a new procedure, progressive balloon dilation following HJ (HJPBD), was designed and utilized in the IBS treatment. We retrospectively compared HJPBD with the traditional HJ in term of the outcomes when used for IBS treatment.ResultsBetween January 1997 and December 2009, 112 patients with IBS attributed to cholecystectomy enrolled in our hospital were treated with surgical reconstruction with either HJ (n=58) or HJPBD (n=54). Of the 58 patients in HJ group, 48 patients (82.8%) had a successful outcome, while 52 out of 54 patients (96.3%) in HJPBD group achieved success. The successful surgical reconstruction rates were significantly different between these two groups, with a further improved outcome in patient undergone progressive balloon dilation following HJ. Additionally, 8 of the 10 failure cases in HJ group were successfully rescued by HJPBD procedure.ConclusionsOur findings suggest that the new procedure of HJPBD could be successfully applied to IBS patients, and significantly improve the outcome of IBS reconstruction.
Highlights
Iatrogenic biliary stricture (IBS) is a disastrous complication of cholecystectomy
Our data showed that the new procedure HJPBD significantly improves outcome of iatrogenic biliary stricture (IBS) repair compared with traditional surgical procedures
Bile duct injuries were observed in 66 patients within 7 days post-cholecystectomy, and had been initially treated with T tube drainage (n =23), bile duct end-toend anastomosis (n=31) or local tissue repairs (n =12)
Summary
The endoscopic treatments are well accepted as initial attempts for IBS, surgical hepaticojejunostomy (HJ) is often necessary for a considerable proportion of patients. Delayed detection and inappropriate treatment of BDI post cholecystectomy are often complicated by biliary strictures. This type of bile duct stricture is treated non-surgically or by surgical hepaticojejunostomy (HJ). Endoscopic or radiologic interventions have often been initially attempted, but in vain in a considerable number of patients because of failure of guide-wire passage through the stricture site [4,5,6]. The outcome of HJ for iatrogenic biliary stricture (IBS) is usually favorable, but a small proportion of patients suffer anastomotic stricture and recurrent bile duct stricture [7,8]. Only a small proportion of patients suffer failure, it remains unacceptable, because of the repeated cholangitis, biliary cirrhosis or even death just caused by what seems to be a simple operation, cholecystectomy
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