Management of Benign Biliary Strictures

Abstract

Benign biliary strictures are most commonly a consequence of injury at laparoscopic cholecystectomy or fibrosis after biliary-enteric anastomosis. These strictures are notoriously difficult to treat and traditionally are managed by resection and fashioning of a choledocho- or hepato-jejunostomy. Promising results are being achieved with newer minimally invasive techniques using endoscopic or percutaneous dilatation and/or stenting and these are likely to play an increasing role in the management. Even low-grade biliary obstruction carries the risks of stone formation, ascending cholangitis and hepatic cirrhosis and it is important to identify and treat this group of patients. There is currently no consensus on which patient should have what type of procedure, and the full range of techniques may not be available in all hospitals. Careful assessment of the risks and likely benefits have to be made on an individual basis. This article reviews the current literature and discusses the options available. The techniques of endoscopic and percutaneous dilatation and stenting are described with evaluation of the likely success and complication rates and compared to the gold standard of biliary-enteric anastomosis.

Percutaneous Treatment of Benign Biliary Strictures and Biliary Manometric Perfusion Test

“…The success rate and long term results of percutaneous treatment of benign strictures are reviewed and discussed in a number of articles 1,5,7,9,[11][12][13][14][15][16] . The percutaneous treatment of these strictures by dilatation has a success rate from 60 to 90 % 1 .…”

“…The parameters for hepatic synthetic function are levels of plasma albumin and clotting factors, as assessed by the prothrombin time, but these will be changed only in advanced decompensated stages. However, gamma glutamyl transferase is the most sensitive indicator for hepatocellular damage 5 . Hepatic scintigraphy with imino diacetic acid compounds is highly sensitive to biliary obstruction, but in practice they add little information over biochemical and radiological investigations.…”

Common bile duct stones, an experience in Ondokuz Mayis University

“…In the recent years, mortality after BEA and CD for benign biliary structure decreased from 10% to 1% (Blankensteijn et al, 1990;Chapman et al, 1995;Tocchi et al, 2001;Laasch et al, 2002;Sicklick et al, 2005).…”

“…Most frequent complications were wound infection (23%) and bile leakage (up to 13%). (Blankensteijn et al,1990;Chapman et al,1995;Tocchi et al,2001;Laasch et al,2002;Sicklick et al,2005;Zafar et al,2011).…”

Biliary Manometric Perfusion Test in the Evaluation of Benign Biliary Stricture Treatment - A Case Report

“…Postoperative strictures are the most frequent [5][6][7] . Even though the strictures are benign, long standing benign biliary strictures can lead to recurrent episodes of ascending cholangitis, liver abscesses, biliary cirrhosis and portal hypertension.…”