X-ray surgery for benign biliary strictures after cholecystectomy

Abstract

Aim.To determine the role of antegrade X-ray surgical interventions in the treatment of benign postoperative biliary strictures.Material and methods.A retrospective analysis of treatment of 36 patients with benign biliary strictures was performed. Isolated stricture of biliodigestive anastomosis was diagnosed in 25 cases, partial clipping of common hepatic duct proximal to biliodigestive anastomosis – in 3 cases, partial clipping of bile duct – in 3 patients, isolated biliary strictures – in 5 patients including 4 of them with stricture within previously deployed T-shaped drainage. At the first stage, percutaneous transhepatic cholangiostomy was performed. According to antegrade cholangiography data, structure type “+1, +2” by H. Bismuth classification in modification of E. I. Galperin was diagnosed in 16 (55.2%) patients, proximal biliary strictures (“0”–“−2”) in 13 patients. Three patients with partial clipping of common bile duct and 4 patients with benign biliary stricture in the area of previously deployed T-shaped drainage were not classified. Recanalization of strictures by “catheter-guide” system was followed by antegrade dilatation of the stricture. Final stage was frame external-internal drainage for 6–12 months with stepwise redo balloon dilatation every 3 months (35 patients). The criterion for the end of minimally invasive treatment was the absence of balloon waist in the stricture zone observed during the next procedure but not earlier than in 6 months from primary balloon dilatation. Surgical correction was indicated for recurrent stricture.Results.Direct technical success was achieved in 35 patients. There was 1 case of recurrent strictures within 1 year among 3 cases of primary repair of biliary strictures in the area of previously installed T-shaped drainage. Resection of common bile duct stricture was followed by Roux-en-Y hepaticojejunostomy. Recurrence-free period among 36 patients ranged from 1 to 10 years, median – 56 months. There were no mortality and complications after X-ray surgery.Conclusion.Antegrade recanalization and balloon dilatation of the stricture followed by long-term external-internal biliodigestive frame drainage are effective for both stricture of biliodigestive anastomosis and partial clipping of bile duct. Conventional surgical procedures should be preferred for cicatricial strictures of extrahepatic bile ducts after previous T-shaped drainage deployment.