Surgical management of benign strictures of the biliary tract

Abstract

Benign strictures of the biliary tract are difficult to treat surgical complications. Most biliary strictures result from injuries during cholecystectomies, and their initial management is a major determining factor of the long-term outcome. Only surgeons well trained and experienced in their management should treat this entity. The affected patients present various signs and symptoms depending on the time the lesion is detected, and the treatment modality largely depends on such timing. The success of surgical treatment with its attendant low morbidity and mortality makes it the preferred modality over transhepatic image-guided or endoscopic balloon dilatation, with or without the insertion of stents. Surgical treatment is based on three principles: good exposure for internal drainage of the intrahepatic biliary tract, mucosa-to-mucosa anastomosis, and prevention of the risk of reoperation for recurrent stenosis. Roux-en-Y hepaticojejunostomy with a blind subcutaneous jejunal loop seems to comply with these three principles. Transanastomotic stents are not necessary. We have analyzed our experience from 1988 to 1999 with 65 consecutive patients referred to us for biliary reconstruction. We used the Roux-en-Roux-en-Y hepaticojejunostomy with a blind subcutaneous jejunal loop, performed by the same surgical group in all cases.