Recurrent biliary stricture

Pellegrini, Carlos A.; Thomas, M; Way, Lawrence W.

doi:10.1016/0002-9610(84)90054-0

Cited by 191 publications

(45 citation statements)

References 16 publications

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“…The success of the procedure depends on precise surgical technique, which involves tension-free, mucosa-to-mucosa approximation between the healthy bile duct and the jejunum with a wide anastomotic stoma. As already mentioned, recurrence of the stricture is a known complication of the procedure [1, 2], Pitt et al [2]reported that 68% of their recurrences came within 3 years of their last repair and 80% within 5 years. Two thirds of patients in another series became symptomatic within 2 years of the last repair and 90% did so within 7 years [1].…”

Section: Discussionmentioning

confidence: 99%

“…As already mentioned, recurrence of the stricture is a known complication of the procedure [1, 2], Pitt et al [2]reported that 68% of their recurrences came within 3 years of their last repair and 80% within 5 years. Two thirds of patients in another series became symptomatic within 2 years of the last repair and 90% did so within 7 years [1]. Twenty (49%) patients in our series presented within 1 year of the last surgery and 38 (93%) presented within 3 years, the longest interval being 5 years.…”

Section: Discussionmentioning

confidence: 99%

“…An important issue left unaddressed in all the reports discussing revisional surgery for bile duct injuries, is the cause of the recurrence of the stricture [1, 2, 3, 9]. Are these stenoses inevitable or are they preventable?…”

Section: Discussionmentioning

confidence: 99%

“…Major bile duct injuries following cholecystectomy need surgical repair and a Roux-en-Y hepaticojejunostomy is generally the optimum procedure in this situation. Operative repair of iatrogenic bile duct strictures has a long-term recurrent stricture rate of 10–30% [1, 2]and though there are many reports pertaining to the surgical management of postcholecystectomy bile duct strictures, only a few of them specifically address the issue of recurrent biliary strictures [1, 2, 3]. This paper reports our experience with patients treated for recurrent biliary stricture following a surgical repair performed for a postcholecystectomy bile duct injury.…”

Section: Introductionmentioning

confidence: 99%

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Reoperative Surgery for Postcholecystectomy Bile Duct Injuries

et al. 2002

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Background: Surgical repair for a postcholecystectomy bile duct injury can be complicated by the development of an anastomotic stricture which necessitates re-intervention. The authors reviewed their experience with patients requiring re-operation after unsuccessful surgical repair of the bile duct injury, to analyze the possible causes of the failure of the operative procedure and the long-term outcome following revisional surgery. Methods: Retrospective analysis of the records of 41 patients referred to a tertiary care center for the management of recurrent stricture following surgical repair performed for a postcholecystectomy bile duct injury. Results: Before referral, 69 operative procedures had been performed on these 41 patients. Factors likely to be associated with increased chances of failure of the biliary reconstructive procedures included presentation with cholangitis after the biliary injury, no cholangiographic study before the surgical repair and surgical intervention within 3 weeks of the injury. Thirty-seven (90%) patients were found to have strictures at or above the level of confluence of right and left hepatic ducts, while at the time of the index repair only 12 (29%) patients had an injury at that level. Revisional surgery in all the patients was a Roux-en-Y hepaticojejunostomy. One patient died, 2 patients with multiple previous operations developed recurrence and needed intervention again. Over a mean follow-up period of 4.2 years, 90% patients had a satisfactory outcome. Conclusion: Development of recurrent stricture following surgical repair of a postcholecystectomy biliary injury can be related to the technique and timing of the surgical procedure, the complication may therefore be avoidable in some patients. In experienced hands the results of revisional surgery are good but are adversely affected as the number of previous repairs increases.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Reoperative Surgery for Postcholecystectomy Bile Duct Injuries

et al. 2002

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“…Transanastomotic tubes have been used by the vast majority of authors [5,8,10,13,22,23,[28][29][30][31], although some use them selectively [9,11,12]. How long tubes should be kept in place is controversial.…”

Section: Figurementioning

confidence: 99%