Recurrent cholangitis with and without anastomotic stricture after biliary-enteric bypass.

We recently surgically treated 24 patients incapacitated by recurrent cholangitis after biliary-enteric anastomosis performed for benign disease. Contrary to commonly held dogma, as many as one third of the patients had no evidence of anastomotic stricture indicated by radiologic and operative findings. We identified several other primary and coexistent pathogenetic factors including intrahepatic stricture in 42% of the patients, intrahepatic calculi in 25%, improperly constructed enteric conduits in 13%, and conditions that predispose to bacterial overgrowth in the biliary tree in 17%. Seventy-one percent of the patients had multiple etiologic factors, and of those patients without demonstrable anastomotic stricture, intrahepatic stricture was particularly common. Seventy-one percent remained symptom-free in their first year after operation. The most difficult situation to manage, and the factor responsible for most recurrences after our reoperation, involved intrahepatic stricture. A combined surgical and interventional radiologic approach to complex cases may be useful in selected patients.