Long-term outcome of percutaneous treatment and surgery for postoperative benign biliary stricture

The aim of this study was to assess the therapeutic efficacy and long-term outcome of percutaneous and surgical treatment in patients with postoperative biliary stricture. The subjects consisted of 19 patients with postoperative benign biliary stricture secondary to bile duct injury or fibrosis at the bilioenterostomy. All of the patients were initially managed by percutaneous transhepatic biliary drainage. Five patients failed to achieve internalization across the stricture and then underwent a wide hilar hepaticojejunostomy. An additional 4 patients required surgery because of a complex injury involving the right hepatic artery in one and the occurrence of so-called 'blind-loop syndrome' in 3. Hepatobiliary scintigraphy clearly demonstrated a functional obstacle in the bile flow in these patients. Percutaneous management with an internal/external catheter placement was accomplished in 10 patients. A successful outcome was achieved in all patients with a mean follow-up 6.7 (range 2-12) and 5.2 (range 1-12) years for the surgical and percutaneous treatment, respectively. Conclusively, postoperative biliary stricture requires multidisciplinary management. The surgical repair should therefore be carefully considered for cases with tight stricture, a complex injury, or blind-loop syndrome. In order to accurately characterize the biliary flow and to select the optimal treatment, hepatobiliary scintigraphy may thus provide us with helpful information. (author)