Benign biliary stricture(BBS), mainly caused by iatrogenic injury, is a disastrous disease which progresses to biliary cirrhosis, portal hypertension and bleeding esophageal varices. Therefore, early recognition and correct management are
required
for a
successful outcome.
The clinical features of 28 consecutive patients with postoperative benign biliary stricture, treated at the Department of Surgery, Seoul National University Hospital are reviewed in this report, with special attention to type of stricture, type
of
reparative operation and its operative result.
1) The patients profile is as follows; male: female ratio of 1.3:1(16 :12), age range of 18 to 65 years(mean age: 44.7 years).
2) Diagnosis was made by cholangiography, and the sensitivities of radiologic studies were 100%(2/2) with TTC, 87.5%(14/16) with PCT, 37.5(6/16) with ERCP and 37.5%(9/25) with USG.
3) The underlying disease were mainly cholelithiasis.(82.1%)
4) The causative previous operations were cholecystectomy with CBD exploration(39.3%), cholecystectomy alone(32.1%) and biliary-enteric anastomosis(17.9%).
5) Forty eight percent of benign biliary stricture was developed within 2 years after previous operation and 66.7%, within 5 years.
6) Type I stricture were 50% and type II stricture was 28.6%. Type I or type II stricture which developed after cholecystectomy and CBD exploration was 81.3%, and after biliary-enteric anastomosis, 80%.
7) Success rate after reparative operation was 89.3% as a whole, 85% after biliary-enteric anastomosis and 90.9% in type I and type II stricture.
Cholangiography, especially PTC was the most efficient diagnostic tool. More than half of postoperative BBS were developed more than 2 years after primary operation. Therefore, postoperative long-term follow up is recommended. As a reparative
operation,
biliary-enteric anastomosis gained a good outcome. But in properly selected cases, insertion of stent could be an alternative. Type of stricture was an important factor determining outcome of repair.
|