Biliary stricture.

Comparison of our results for the past 14 years with those from the period 1940 through 1968 shows that surgical therapy in the repair of biliary stricture has plateaued at a consistent level of more than 90 per cent success. The selection of an operative procedure and its conduct have become standardized based on the principles discussed earlier. The patients that have an unsatisfactory outcome are for the most part predictable. They are mainly those with biliary cirrhosis and its complications, ineradicable intrahepatic stone formation, or rare injuries that are technically incorrectable. Current experience reinforces our previous observation that a history of one or more previous unsuccessful repairs does not preclude success after another attempt. More than 80 per cent of such patients have been rendered symptom-free by stricture repair (Table 3). Since surgical therapy eliminates the need for external tubes and the perpetual morbidity of other forms of palliative therapy, it remains the mainstay of treatment for all but a handful of patients.