Skip to main content
PMC home page
Annals of Surgery logoLink to Annals of Surgery
. 1996 Jun;223(6):639–648. doi: 10.1097/00000658-199606000-00002

Long-term follow-up after bilioenteric anastomosis for benign bile duct stricture.

W H Nealon 1, F Urrutia 1
PMCID: PMC1235203  PMID: 8645037

Abstract

OBJECTIVE: The authors provide a prospective evaluation of long-term results after bilioenteric anastomoses for benign biliary stricture. SUMMARY BACKGROUND DATA: With the advent of laparoscopic techniques, the frequency of bile duct injury after operation has increased. Reports on the operative management of these injuries have not provided long-term follow-up. Over a similar period, reports of both endoscopic and invasive radiographic methods as primary treatment for bile duct stricture have compared success rates to antiquated surgical reports. METHODS: A protocol whereby preoperative radiographic (e.g., cholangiogram, computed tomographic scan, ultrasound), biochemical (e.g., alkaline phosphatase, and total bilirubin), and clinical evaluation was combined with ongoing postoperative evaluation and follow-up at approximately 6-month intervals. A total of 111 patients were evaluated from 1985 to 1995. Patients were categorized in three groups: 1) those with postoperative injuries during open and laparoscopic gallbladder surgery (31 patients), 2) those undergoing operation for pain associated with chronic pancreatitis who have distal common bile duct stenoses (64 patients), and 3) those with nonchronic pancreatitis-associated benign bile duct strictures (16 patients). RESULTS: Mean follow-up was 60 months. Overall preoperative alkaline phosphatase was 640 units/L with a range of 280 to 1860 units/L. All patients had abnormally elevated alkaline phosphatase. Only 3 of 111 patients have had mild persistent elevation after operation. Clinical jaundice, present in 49 of 111 patients, was resolved uniformly by operative decompression. Total bilirubin was elevated abnormally in 56 of 111 patients and also was uniformly corrected by operation. CONCLUSIONS: These data support the careful combined use of endoscopy, invasive radiology, and surgery in the management of benign strictures of the biliary tree. These data further suggest a success rate for surgical management that, over long-term follow-up, appears to exceed that found using alternative measures. Alternative methods should measure their success rates against success rates currently achieved by operative management.

Full text

PDF

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Asbun H. J., Rossi R. L., Lowell J. A., Munson J. L. Bile duct injury during laparoscopic cholecystectomy: mechanism of injury, prevention, and management. World J Surg. 1993 Jul-Aug;17(4):547–552. doi: 10.1007/BF01655122. [DOI] [PubMed] [Google Scholar]
  2. Barthet M., Bernard J. P., Duval J. L., Affriat C., Sahel J. Biliary stenting in benign biliary stenosis complicating chronic calcifying pancreatitis. Endoscopy. 1994 Sep;26(7):569–572. doi: 10.1055/s-2007-1009041. [DOI] [PubMed] [Google Scholar]
  3. Blumgart L. H., Hadjis N. S., Benjamin I. S., Beazley R. Surgical approaches to cholangiocarcinoma at confluence of hepatic ducts. Lancet. 1984 Jan 14;1(8368):66–70. doi: 10.1016/s0140-6736(84)90002-3. [DOI] [PubMed] [Google Scholar]
  4. Branum G., Schmitt C., Baillie J., Suhocki P., Baker M., Davidoff A., Branch S., Chari R., Cucchiaro G., Murray E. Management of major biliary complications after laparoscopic cholecystectomy. Ann Surg. 1993 May;217(5):532–541. doi: 10.1097/00000658-199305010-00014. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Deziel D. J., Millikan K. W., Economou S. G., Doolas A., Ko S. T., Airan M. C. Complications of laparoscopic cholecystectomy: a national survey of 4,292 hospitals and an analysis of 77,604 cases. Am J Surg. 1993 Jan;165(1):9–14. doi: 10.1016/s0002-9610(05)80397-6. [DOI] [PubMed] [Google Scholar]
  6. Goldin E., Beyar M., Safra T., Globerman O., Verstandig A., Wengrower D., Fich A. A new self-expandable and removable metal stent for biliary obstruction--a preliminary report. Endoscopy. 1993 Nov;25(9):597–599. doi: 10.1055/s-2007-1010412. [DOI] [PubMed] [Google Scholar]
  7. Lee M. J., Mueller P. R., Saini S., Hahn P. F., Dawson S. L. Percutaneous dilatation of benign biliary strictures: single-session therapy with general anesthesia. AJR Am J Roentgenol. 1991 Dec;157(6):1263–1266. doi: 10.2214/ajr.157.6.1950878. [DOI] [PubMed] [Google Scholar]
  8. Lillemoe K. D., Pitt H. A., Cameron J. L. Current management of benign bile duct strictures. Adv Surg. 1992;25:119–174. [PubMed] [Google Scholar]
  9. Matthews J. B., Baer H. U., Schweizer W. P., Gertsch P., Carrel T., Blumgart L. H. Recurrent cholangitis with and without anastomotic stricture after biliary-enteric bypass. Arch Surg. 1993 Mar;128(3):269–272. doi: 10.1001/archsurg.1993.01420150023004. [DOI] [PubMed] [Google Scholar]
  10. Nealon W. H., Townsend C. M., Jr, Thompson J. C. Preoperative endoscopic retrograde cholangiopancreatography (ERCP) in patients with pancreatic pseudocyst associated with resolving acute and chronic pancreatitis. Ann Surg. 1989 May;209(5):532–540. doi: 10.1097/00000658-198905000-00004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Soper N. J., Flye M. W., Brunt L. M., Stockmann P. T., Sicard G. A., Picus D., Edmundowicz S. A., Aliperti G. Diagnosis and management of biliary complications of laparoscopic cholecystectomy. Am J Surg. 1993 Jun;165(6):663–669. doi: 10.1016/s0002-9610(05)80784-6. [DOI] [PubMed] [Google Scholar]
  12. Traverso L. W., Hauptmann E. M., Lynge D. C. Routine intraoperative cholangiography and its contribution to the selective cholangiographer. Am J Surg. 1994 May;167(5):464–468. doi: 10.1016/0002-9610(94)90235-6. [DOI] [PubMed] [Google Scholar]
  13. Warshaw A. L., Schapiro R. H., Ferrucci J. T., Jr, Galdabini J. J. Persistent obstructive jaundice, cholangitis, and biliary cirrhosis due to common bile duct stenosis in chronic pancreatitis. Gastroenterology. 1976 Apr;70(4):562–567. [PubMed] [Google Scholar]
  14. Woods M. S., Traverso L. W., Kozarek R. A., Tsao J., Rossi R. L., Gough D., Donohue J. H. Characteristics of biliary tract complications during laparoscopic cholecystectomy: a multi-institutional study. Am J Surg. 1994 Jan;167(1):27–34. doi: 10.1016/0002-9610(94)90050-7. [DOI] [PubMed] [Google Scholar]
  15. vanSonnenberg E., Casola G., Wittich G. R., Christensen R., Varney R. R., Neff C. C., D'Agostino H. B., Moossa A. R. The role of interventional radiology for complications of cholecystectomy. Surgery. 1990 Jun;107(6):632–638. [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES