Surgical treatment of blocked mesh metal biliary stents

Abstract

Background Biliary mesh metal stents occlude due to tumour ingrowth or biliary sludge. Surgical intervention is rarely considered. Methods Three patients, two with biliary tract cancers and metastases and one following liver transplantation, developed mesh metal stent occlusion at three, four, and eight months following insertion. Internal plastic stents were subsequently used on two occasions in two of the three patients. The patients underwent surgical drainage of the biliary tract. Results A Roux en Y jejunal loop was mobilised and anastomosed to the common hepatic duct or to both right and left hepatic ducts. All three patients had complete resolution of clinical jaundice and sepsis. Discussion The optimal management of blocked mesh metal stents has not been established. Operative treatment may be appropriate in selected cases with good life expectancy.