Post-operative Benign Bile Duct Stricture

Choi, Seong Ho; Kim, Yong Il; Sohn, Tae Sung; Noh, Jae Hyung; Joh, Jae Won; Kim, Sung Ju

Abstract

BACKGROUND/AIMS: Benign bile duct stricture from iatrogenic injury is a serious complication in general surgery. In spite of more knowledge and improved techniques, bile duct stricture remains a critical problem.
METHOD AND RESULTS
We have experienced eight cases of post-operative bile duct stricture between September 1994 and April 1996. 6 cases of Initial operations were done in SMC, and two cases were transferred. The cases were analysed. The causative operations consisted of two cholecystectomy with bile duct exploration, three Whipples procedure, one right lobectomy of liver, one duodenal diverticulectomy and one Billorth I gastrectomy. According to the classification of Bismuth, three were type 1, two were type 2, two were type 3 and one was type 4. The pathogenesis of stricture included direct injury in five cases, ischemia in one and excessive fibrosis in two. PTBD was used and repaired by hepaticojejunostomy in all cases. Even after short-term follow-up, we had no recurrent cases.
CONCLUSION
Bile duct injury is an inevitable complication, but prophylaxis is the best treatment and therefore more attention must be given to biliary tree anatomy during upper abdominal surgery, especially during aggressive lymph node dissection in malignant disease. When bile duct injury was discovered during operation, Roux-en-Y hepaticojejunostomy was the best treatment. We preferred 2.5 magnification loupe during bilo-enteric anastomosis in normal size bile duct. PTBD was used for corrective surgery and the results were satisfactory.