BACKGROUND: Biliary metallic stents (MS) are being used increasingly to treat patients with malignant bile duct strictures. In patients with benign strictures, MS are contraindicated because these stents are considered unremovable. The aim of this study was to report the operative treatment of patients with benign biliary strictures at the hepatic confluence stented with MS. METHODS: Five patients with a benign hilar stenosis stented with MS underwent liver resection with biliodigestive anastomoses. The operations were designed to remove all MS by a combined biliary and hepatic resection. RESULTS: After preoperative portal vein embolization in 2 patients and percutaneous biliary drainage in 2 others, all underwent a major hepatectomy with resection of the biliary confluence and a biliodigestive anastomosis. One patient also underwent resection of the portal vein bifurcation that could not be freed from the bile duct wall. Four patients experienced postoperative complications. With a mean follow-up of 37 months (range, 31-47 months), all patients have remained symptom-free. CONCLUSIONS: Operative treatment of benign hilar strictures in patients with MS is possible if they are managed similarly as patients with hilar malignancies. This demanding procedure should be considered an alternative to liver transplantation for benign strictures treated with MS, but the procedure requires expertise in advanced hepatic resections.
BACKGROUND: Biliary metallic stents (MS) are being used increasingly to treat patients with malignant bile duct strictures. In patients with benign strictures, MS are contraindicated because these stents are considered unremovable. The aim of this study was to report the operative treatment of patients with benign biliary strictures at the hepatic confluence stented with MS. METHODS: Five patients with a benign hilar stenosis stented with MS underwent liver resection with biliodigestive anastomoses. The operations were designed to remove all MS by a combined biliary and hepatic resection. RESULTS: After preoperative portal vein embolization in 2 patients and percutaneous biliary drainage in 2 others, all underwent a major hepatectomy with resection of the biliary confluence and a biliodigestive anastomosis. One patient also underwent resection of the portal vein bifurcation that could not be freed from the bile duct wall. Four patients experienced postoperative complications. With a mean follow-up of 37 months (range, 31-47 months), all patients have remained symptom-free. CONCLUSIONS: Operative treatment of benign hilar strictures in patients with MS is possible if they are managed similarly as patients with hilar malignancies. This demanding procedure should be considered an alternative to liver transplantation for benign strictures treated with MS, but the procedure requires expertise in advanced hepatic resections.
Authors: Eric Vibert; Daniel Azoulay; Thomas Aloia; Gérard Pascal; Luc-Antoine Veilhan; René Adam; Didier Samuel; Denis Castaing Journal: Ann Surg Date: 2007-07 Impact factor: 12.969