Benign biliary stricture represents a significant clinical problem, despite of the technological development that has facilitated diagnosis and management. Without proper treatment, it could cause recurrent cholangitis, biliary cirrhosis, liver
failure,
and death. There are several etiologic factors in benign biliary strictures but almost all cases are related to biliary operation, especially cholecystectomy.
At Asan Medical Center, from July 1989 through June 1993, nineteen patients were managed for post-operative biliary strictures with surgery and radiologic indiologic intervention. Nine patients were treated with surgical repair (Roux-en-Y
choledocho-or
hepaticojejunostomy) ; ten patients were treated with stent placement and 1 balloon dilatation only). All patients had the history of previous billary surgery, 15 cholecystectomy or CBD explo-ration, 2 choledochoenterostomy, and 2 endoscopic
papillostomy. There was no motality after any procedure and mean period of follow-up was 10.2 months (3-36 months) for both groups. In surgery group, 8 patients (89%) showed successful outcome but in radiologic intervention group, only 4-patients
(40%)
showed successful outcome. Minor complications after procedure were 4 cases in surgery group and 3 cases in radiologic intervention group but there was no major complication in both groups. Mean period of hospital stay was 6 days (1-16 days) in
radiologic intervention group and 23.1 days (19-65 days) is surgery group. Five patients required retreatment because of recurrent strictures after endobiliary stenting. In these patients, 3 Roux-en-Y hepaticojejunostomy was performed, 1
pancreaticduodenectomy was done because of a possibility of malignancy and 1 PTBD was done because the patient refused the surgery.
In conclusion, Radiologic intervention for benign biliary strictures provides temporary relief of symptom and might be an alternative treatment, especially in poor risk patients. However, open surgery (mucosa-to-mucosa anastomosis) is superior to
radiologic intervention for definite treatment of postoperative biliary strictures because of fewer problems that require further therapy and excellent outcome. (Korean J Gastroenterol 1994 ; 26 : 697-705)
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