MODERN SURGICAL TACTICS FOR BENIGN BILIARY STRICTURES. TRENDS AND UNRESOLVED ISSUES

Aim. To assess current trends in surgery of benign biliary strictures by using of analysis of long-term results of various biliary interventions performed in the large federal surgical center for a long time. 

Materials and Methods. Surgical treatment of 349 patients with benign biliary strictures has been considered for more than 30 years. Open surgery to restore bile flow was performed in 301 (86%) patients. Percutaneous antegrade transhepatic procedures (balloon dilatation, cholangiostomy) were performed in 48 (14%) patients. Long-term outcomes were estimated in 296 (85%) out of 349 patients. There were 258 patients after open surgery and 38 patients after endobiliary procedures among them.

 Results. Successful results without episodes of cholangitis were achieved in 214 (83%) out of 258 patients. 44 (17%) patients had recurrent stricture within more than 20 year of follow-up. Endobiliary treatment was applied in terms of 6–28 months (mean 17 ± 10 months). In 12 (25%) patients treatment is completed without signs of recurrent stricture (4–24 months of follow-up). 

Conclusion. Further researches including case-control trials are required to develop complete concept of surgical management of benign biliary strictures taking into account the possibilities of percutaneous bile flow restoration.

1. Schmidt S.C., Fikatas P., Denecke T., Schumacher G., Aurich F., Neumann U., Seehofer D. Hepatic resection for patients with cholecystectomy related complex bile duct injury. Eur. Surg. 2010; 42 (2): 77–82. DOI: 10.1007/s10353-010-0524-3.

2. Galperin E.I., Chevokin A.Iu., Kuzovlev N.F., Dyuzheva T.G., Garmaev B.G. Diagnosis and treatment of various types of high cicatricial strictures of the hepatic ducts. Khirurgiya. 2004; 5: 26–31. (In Russian)

3. Chevokin A.Iu. Technical features of precision anastomoses in cicatricial strictures of the bile ducts. Annaly khirurgicheskoy gepatologii. 2011; 16 (3): 79–86. (In Russian)

4. Shapovaliantc S.G., Orlov S.Iu., Budzinskii S.A., Fedorov E.D., Matrosov A.L., Mylnikov A.G. Endoscopic correction of cicatricial strictures of the bile duct. Annaly khirurgicheskoy gepatologii. 2006; 11 (2): 57–64. (In Russian)

5. Ko G.Y., Sung K.B., Yoon H.K., Kim K.R., Gwon D.I., Lee S.G. Percutaneous transhepatic treatment of hepaticojejunal anastomotic biliary strictures after living donor liver transplantation. Liver Transpl. 2008; 14 (9): 1323–1332. DOI: 10.1002/lt.21507.

6. Janssen J.J., van Delden O.M., van Lienden K.P., Rauws E.A., Busch O.R., van Gulik T.M., Gouma D.J., Laméris J.S. Percutaneous balloon dilatation and long-term drainage as treatment of anastomotic and nonanastomotic benign biliary strictures. Cardiovasc. Intervent. Radiol. 2014; 37 (6): 1559–1567. DOI: 10.1007/s00270-014-0836-y.

7. Fidelman N. Benign biliary strictures: diagnostic evaluation and approaches to percutaneous treatment. Tech. Vasc. Interv. Radiol. 2015; 18 (4): 210–217. DOI: 10.1053/j.tvir.2015.07.004.

8. Flum D.R., Cheadle A., Prela C., Dellinger E.P., Chan L. Bile duct injury during cholecystectomy and survival in medicare beneficiaries. JAMA. 2003; 290 (16): 2168–2173. DOI: 10.1001/jama.290.16.2168.

9. Lai E.C., Lau W.Y. Mirizzi syndrome: history, present and future development. ANZ J. Surg. 2006; 76 (4): 251–257. DOI: 10.1111/j.1445-2197.2006.03690.x.

10. Adamsen S., Hansen O.H., Funch-Jensen P., Schulze S., Stage J.G., Wara P. Bile duct injury during laparoscopic cholecystectomy: a prospective nationwide series. J. Am. Coll. Surg. 1997; 184 (6): 571–578. PMID: 9179112.

11. Sahajpal A.K., Chow S.C., Dixon E., Greig P.D., Gallinger S., Wei A.C. Bile duct injuries associated with laparoscopic cholecystectomy timing of repair and long-term outcomes. Arch. Surg. 2010; 145 (8): 757–763. DOI: 10.1001/archsurg.2010.153.

12. Sicklick J.K., Camp M.S., Lillemoe K.D., Melton G.B., Yeo C.J., Campbell K.A., Talamini M.A., Pitt H.A., Coleman J.A., Sauter P.A., Cameron J.L. Surgical management of bile duct injuries sustained during laparoscopic cholecystectomy: perioperative results in 200 patients. Ann. Surg. 2005; 241 (5): 786–792.

13. de Reuver P.R., Rauws E.A., Bruno M.J., Lameris J.S., Busch O.R., van Gulik T.M., Gouma D.J. Survival in bile duct injury patients after laparoscopic cholecystectomy: a multidisciplinary approach of gastroenterologists, radiologists, and surgeons. Surgery. 2007; 142 (1): 1–9. DOI: 10.1016/j.surg.2007.03.004.

14. Chaudhary A., Chandra A., Negi S.S., Sachdev A. Reoperative surgery for postcholecystectomy bile duct injuries. Dig. Surg. 2002; 19 (1): 22–27. DOI: 10.1159/000052001.

15. Chijiiwa K., Yamashita H., Yoshida J., Kuroki S., Tanaka M. Current management and long-term prognosis of hepatolithiasis. Arch. Surg. 1995; 130 (2): 194–197. DOI: 10.1001/archsurg.1995.01430020084016.

16. Ji-Qi Yan, Cheng-Hong Peng, Jia-Zeng Ding, Wei-Ping Yang, Guang-Wen Zhou, Yong-Jun Chen, Zong-Yuan Tao, Hong-Wei Li. Surgical management in biliary restricture after Roux-en-Y hepaticojejunostomy for bile duct injury. World J. Gastroenterol. 2007; 13 (48): 6598–6602. DOI: 10.3748/wjg.v13.i48.6598.

17. Vishnevsky V.A., Kubyshkin V.A., Efanov M.G., Olesov O.D. Posttraumatic stricture of proximal extrahepatic bile ducts. The Protocol report on 2611-th meeting of the Moscow society of surgeons from 18.10.07. Khirurgiya. 2009; 3: 70–72. (In Russian)

18. Hammel P., Couvelard A., O’toole D., Ratouis A., Sauvanet A., Fléjou J.F., Degott C., Belghiti J., Bernades P., Valla D., Ruszniewski P., Lévy P. Dregression of liver fibrosis after biliary drainage in patients with chronic pancreatitis and stenosis of the common bile duct. N. Engl. J. Med. 2001; 344 (6): 418–423.

19. Vishnevskii V.A., Nazarenko I.A. Liver resection in treatment of post-traumatic cicatricial strictures of the bile ducts and gallpurulent hepatic fistulae. Annaly khirurgicheskoy gepatologii. 2003; 8 (2): 85–92. (In Russian)