INTRODUCTION: Failures following Roux-en-Y hepatico-jejunostomy (HJ) for post-cholecystectomy benign bile duct strictures (BBS) pose significant challenge. This study was aimed to find out the factors predicting failure after surgical repair in patients with BBS. METHODS: Between January 1989 and May 2007, 364 patients underwent Roux-en-Y HJ to the hilum for BBS. With a median follow-up of 61 (6-212) months, 334 (92%) patients had successful outcome and 30 (8%) had failure. A multivariate analysis was performed to find out the factors predicting failure. RESULTS: Thirty patients who had failure became symptomatic after a median of 35 months (3 days-190 months) after surgical repair. Out of 30 patients, 11 (37%) were experiencing occasional episodes of cholangitis responding to antibiotics. All have patent anastomosis on nuclear scintigraphy and/or cholangiography. Cholangiogram demonstrated anastomotic stricture in 19/30 (63%) patients. Eighteen patients underwent re-intervention for re-strictures (nine--percutaneous balloon dilatation of the stricture, five--revision HJ, one--right hepatectomy, three--a combination of interventions). One patient refused to undergo a planned percutaneous balloon dilatation. Out of 18 patients, 12 (67%) had successful outcome following re-interventions. One patient who underwent revision HJ after a failed percutaneous balloon dilatation died in the immediate postoperative period. Preoperative bilirubin (p = 0.001), attempted bilio-enteric anastomosis before referral (0.004), cirrhosis (0.006), portal hypertension (p = 0.056), repair in the presence of external biliary fistula (0.000), and spontaneous bilio-enteric fistula (p = 0.011) were the factors found to be predicting failure of surgical repair on multivariate analysis. CONCLUSIONS: Previous attempts of repair and delay in repair which predispose cirrhosis and portal hypertension may cause failure of surgical management in patients with BBS. In patients presenting with external biliary fistula, for a better outcome, surgical repair may be delayed till the fistula resolves.
INTRODUCTION: Failures following Roux-en-Y hepatico-jejunostomy (HJ) for post-cholecystectomy benign bile duct strictures (BBS) pose significant challenge. This study was aimed to find out the factors predicting failure after surgical repair in patients with BBS. METHODS: Between January 1989 and May 2007, 364 patients underwent Roux-en-Y HJ to the hilum for BBS. With a median follow-up of 61 (6-212) months, 334 (92%) patients had successful outcome and 30 (8%) had failure. A multivariate analysis was performed to find out the factors predicting failure. RESULTS: Thirty patients who had failure became symptomatic after a median of 35 months (3 days-190 months) after surgical repair. Out of 30 patients, 11 (37%) were experiencing occasional episodes of cholangitis responding to antibiotics. All have patent anastomosis on nuclear scintigraphy and/or cholangiography. Cholangiogram demonstrated anastomotic stricture in 19/30 (63%) patients. Eighteen patients underwent re-intervention for re-strictures (nine--percutaneous balloon dilatation of the stricture, five--revision HJ, one--right hepatectomy, three--a combination of interventions). One patient refused to undergo a planned percutaneous balloon dilatation. Out of 18 patients, 12 (67%) had successful outcome following re-interventions. One patient who underwent revision HJ after a failed percutaneous balloon dilatation died in the immediate postoperative period. Preoperative bilirubin (p = 0.001), attempted bilio-enteric anastomosis before referral (0.004), cirrhosis (0.006), portal hypertension (p = 0.056), repair in the presence of external biliary fistula (0.000), and spontaneous bilio-enteric fistula (p = 0.011) were the factors found to be predicting failure of surgical repair on multivariate analysis. CONCLUSIONS: Previous attempts of repair and delay in repair which predispose cirrhosis and portal hypertension may cause failure of surgical management in patients with BBS. In patients presenting with external biliary fistula, for a better outcome, surgical repair may be delayed till the fistula resolves.
Authors: K D Lillemoe; G B Melton; J L Cameron; H A Pitt; K A Campbell; M A Talamini; P A Sauter; J Coleman; C J Yeo Journal: Ann Surg Date: 2000-09 Impact factor: 12.969
Authors: S J Savader; K D Lillemoe; C A Prescott; A B Winick; A C Venbrux; G B Lund; S E Mitchell; J L Cameron; F A Osterman Journal: Ann Surg Date: 1997-03 Impact factor: 12.969
Authors: Francesca M Dimou; Deepak Adhikari; Hemalkumar B Mehta; Kelly Olino; Taylor S Riall; Kimberly M Brown Journal: Surgery Date: 2016-07-06 Impact factor: 3.982
Authors: Anne Marthe Schreuder; Olivier R Busch; Marc G Besselink; Povilas Ignatavicius; Antanas Gulbinas; Giedrius Barauskas; Dirk J Gouma; Thomas M van Gulik Journal: Dig Surg Date: 2019-01-17 Impact factor: 2.588
Authors: Edgar Ortiz-Brizuela; José Sifuentes-Osornio; Daniel Manzur-Sandoval; Santiago Mier Y Terán-Ellis; Sergio Ponce-de-León; Pedro Torres-González; Miguel Ángel Mercado Journal: J Gastrointest Surg Date: 2017-07-25 Impact factor: 3.452
Authors: Germán Sánchez-Morales; Emma Castro; Ismael Domínguez-Rosado; Mario Vilatoba; Alan Contreras; Miguel Mercado Journal: Updates Surg Date: 2022-04-12
Authors: Lucie Vištejnová; Václav Liška; Arvind Kumar; Jana Křečková; Ondřej Vyčítal; Jan Brůha; Jan Beneš; Yaroslav Kolinko; Tereza Blassová; Zbyněk Tonar; Michaela Brychtová; Marie Karlíková; Jaroslav Racek; Hynek Mírka; Petr Hošek; Daniel Lysák; Milena Králíčková Journal: Int J Mol Sci Date: 2021-04-21 Impact factor: 5.923