Iatrogenic bile-duct strictures.

Management of iatrogenic stricture of the bile ducts is difficult and is associated with substantial morbidity and mortality. At the Toronto General Hospital, 61 patients with strictures following operative trauma underwent a total of 75 repairs. The overall success rate was 80%. End-to-end duct repair is preferred when feasible; 8 of the 61 patients were treated this way, with success in 7. In the majority of patients, however, extensive duct scarring and shortening preclude its use, necessitating Roux-en-Y hepaticojejunostomy, done in 53 cases. If the anastomosis is adequate, with good mucosal approximation, a stent is not essential and of 12 such operations, 10 were successful. Even when the mucosa-to-mucosa apposition is less than optimal, the use of a straight-tube stent or changeable U-tube stent may produce a satisfactory end result. Of 41 such operations, 31 were successful. Since iatrogenic bile-duct strictures lead to high morbidity and frequent recurrence despite seemingly adequate repair, continued emphasis should be placed on prevention of injury, especially during routine cholecystectomy. Experience, careful dissection, knowledge of anatomic variations and good judgement concerning the performance of a cholecystostomy in difficult situations, should all reduce this complication to a minimum.