Comparative characteristics of reconstructive surgery and percutaneous balloon dilatation in the treatment of high benign strictures of the bile ducts

Aim: to compare the long-term results of various surgical treatment options for patients with high benign strictures of the bile ducts.

Materials and methods. From 2012 to 2018, 87 patients with strictures of different levels according to the classification of E.I. Halperinwas observed. A stricture of type «0» was detected in 23 patients, type «−1» in 20, type «−2» in 31, type «−3» in 13 (E3 – 43, E4 – 31, E5 – 13 according to classification Bismuth-Strasberg). Open reconstructive interventions were performed in 63 patients, 24 percutaneous endobiliary ones.

Results. Long-term results were traced in 77 (89%) patients, the follow-up period after reconstructive operations was 4.7 ± 1.6 years, after percutaneous – 2.0 ± 1.4 years. Excellent and good results according to the Terblanche classification were achieved in 31 (58%) patients after open reconstructive operations and in 18 (78%) after percutaneous transhepatic biliary drainage.

Conclusion. Technically the most difficult for reconstructive and percutaneous interventions on the bile ducts with a high recurrence rate are strictures of types «−2» and «−3» (E4 and E5). A comparative analysis of the long-term results of percutaneous and open interventions showed a statistically significant advantage of percutaneous interventions compared with reconstructive (p = 0.05).

1. Emel'yanov S.I., Panchenkov D.N., Mamalygina L.A. Surgical treatment of intraoperative extrahepatic bile duct injuries. Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery. 2005; 10 (3): 55–61. (In Russian)

2. Nichitajlo M.E., Skums A.B., Galochka I.P. Bile duct injury in laparoscopic cholecystectomy. Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery. 2005; 10 (2): 30–35. (In Russian)

3. Nuzzo G., Giuliante F., Giovannini I., Ardito F., D’Acapito F., Vellone M., Murazio M., Capelli G. Bile duct injury during laparoscopic cholecystectomy: results of an Italian national survey on 56 591 cholecystectomies. Arch. Surg. 2005; 140 (10): 986–992. https://doi.org/10.1001/archsurg.140.10.986

4. Galperin E.I., Chevokin A.Yu. Intraoperative injuries of bile ducts. Pirogov Russian Journal of Surgery = Khirurgiya. Zhurnal imeni N.I. Pirogova. 2010; 10: 4–10. (In Russian)

5. Park J.K., Yang J.I., Lee J.K., Park J.K., Lee K.H., Lee K.T., Joh J.W., Kwon C.H.D., Kim J.M. Long-term outcome of endoscopic retrograde biliary drainage (ERBD) of biliary stricture following living donor liver transplantation. Gut Liver. 2020; 14 (1): 125–134. https://doi.org/10.5009/gnl18387

6. Bagante F., Ruzzenente A., Beal E.W., Campagnaro T., Merath K., Conci S., Akgül O., Alexandrescu S., Marques H.P., Lam V., Shen F., Poultsides G.A., Soubrane O., Martel G., Iacono C., Guglielmi A., Pawlik T.M. Complications after liver surgery: a benchmark analysis. HPB (Oxford). 2019; 21 (9): 1139–1149. https://doi.org/10.1016/j.hpb.2018.12.013

7. Ito T., Sugiura T., Okamura Y., Yamamoto Y., Ashida R., Aramaki T., Endo M., Matsubayashi H., Ishiwatari H., Uesaka K. Late benign biliary complications after pancreatoduodenectomy. Surgery. 2018; 163 (6): 1295–1300. https://doi.org/10.1016/j.surg.2018.02.015

8. Khirurgicheskaya pomoshch' v Rossijskoj Federacii [Surgical care in the Russian Federation].Information and analytical collection. Scientific Research Center for Surgery named after A.V. Vishnevsky, Moscow. 2018. 136 p. (In Russian)

9. Huszár O., Kokas B., Mátrai P., Hegyi P., Pétervári E., Vincze Á., Pár G., Sarlós P., Bajor J., Czimmer J., Mosztbacher D., Márta K., Zsiborás C., Varjú P., Szücs Á. Meta-analysis of the long term success rate of different interventions in benign biliary strictures. PLoS One. 2017; 12 (1): e0169618. https://doi.org/10.1371/journal.pone.0169618

10. Pitt H.A., Miyamoto T., Parapatis S.K., Tompkins R.K., Longmire W.P. Jr. Factors influencing outcome in patients with postoperative biliary strictures. Am. J. Surg. 1982; 144 (1): 14–21. https://doi.org/10.1016/0002-9610(82)90595-5

11. Blumgart L.H., Kelley C.J., Benjamin I.S. Benign bile duct strictures following cholecystectomy: critical factors in management. Br. J. Surg. 1984; 71 (11): 836–843. https://doi.org/10.1002/bjs.1800711110

12. Pellegrini C.A., Thomas M.J., Way L.W. Recurrent biliary stricture. Patterns of recurrence and outcome of surgical therapy. Am. J. Surg. 1984; 147 (1): 175–180. https://doi.org/10.1016/0002-9610(84)90054-0

13. Vitale G.C., Tran T.C., Davis B.R., Vitale M., Vitale D., Larson G. Endoscopic management of postcholecystectomy bile duct strictures. J. Am. Coll. Surg. 2008; 206 (5): 918–923. https://doi.org/10.1016/j.jamcollsurg.2008.01.064

14. Skinner M., Popa D., Neumann H., Wilcox C., Mönkemüller K. ERCP with the overtube-assisted enteroscopy technique: a systematic review. Endoscopy. 2014; 46 (07): 560–572. https://doi.org/10.1055/s-0034-1365698

15. Pekolj J., Yanzón A., Dietrich A., Del Valle G., Ardiles V., de Santibañes E. Major liver resection as definitive treatment in post-cholecystectomy common bile duct injuries. World J. Surg. 2015; 39 (5): 1216–1223. https://doi.org/10.1007/s00268-014-2933-0

16. Kulezneva Yu.V., Melekhina O.V., Kurmanseitova L.I., Efanov M.G., Cvirkun V.V., Alihanov R.B., Patrushev I.B. X-ray surgical treatment of benign strictures of biliodigestive anastomosis: questions for discussion. Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery. 2017; 20 (3): 45–54. https://doi.org/10.16931/1995-5464.2017345-54 (In Russian)

17. Lindquester W.S., Prologo J.D., Krupinski E.A., Peters G.L. Structured protocol for benign biliary anastomotic strictures: impact on long-term clinical effectiveness. AJR Am. J. Roentgenol. 2018; 210 (2): 447–453. https://doi.org/10.2214/AJR.17.18236

18. Weber A., Rosca B., Neu B., Rösch T., Frimberger E., Born P., Schmid R.M., Prinz C. Long-term follow-up of percutaneous transhepatic biliary drainage (PTBD) inpatients with benign bilioenterostomy stricture. Endoscopy. 2009; 41 (4): 323–328. https://doi.org/10.1055/s-0029-1214507

19. Kirkpatrick D.L., Hasham H., Collins Z., Johnson P., Lemons S., Shahzada H., Hunt S.L., Walter C., Hill J., Fahrbach T. The utility of a benign biliary stricture protocol in preventing symptomatic recurrence and surgical revision. J. Vasc. Interv. Radiol. 2018; 29 (5): 688–694. https://doi.org/10.1016/j.jvir.2017.10.032

20. Mauri G., Michelozzi C., Melchiorre F., Poretti D., Pedicini V., Salvetti M., Criado E., FalcòFages J., De Gregorio M.Á., Laborda A., Sonfienza L.M., Cornalba G., Monfardini L., Panek J., Andrasina T., Gimenez M. Benign biliary strictures refractory to standard bilioplasty treated using polydoxanone biodegradable biliary stents: retrospective multicentric data analysis on 107 patients. Eur. Radiol. 2016; 26 (11): 4057–4063. https://doi.org/10.1007/s00330-016-4278-6.

21. Mercado M.A., Orozco H., de la Garza L., LópezMartínez L.M., Contreras A., Guillén-Navarro E. Biliary duct injury: partial segment IV resection for intrahepatic reconstruction of biliary lesions. Arch. Surg. 1999; 134 (9): 1008–1010. https://doi.org/10.1001/archsurg.134.9.1008

22. Stilling N.M., Fristrup C., Wettergren A., Ugianskis A., Nygaard J., Holte K., Bardram L., Sall M., Mortensen M.B. Long-term outcome after early repair of iatrogenic bile duct injury. A national Danish multicentre study. HPB (Oxford). 2015; 17 (5): 394–400. https://doi.org/10.1111/hpb.12374

23. Chuan Li., Tianfu Wen. Surgical management of hepatolithiasis: aminireview. Intractable Rare Dis. Res. 2017; 6 (2): 102–105. https://doi.org/10.5582/irdr.2017.01027

24. Mercado M.A., Domínguez I. Classification and management of bile duct injuries. World J. Gastrointest. Surg. 2011; 3 (4): 43–48. https://doi.org/10.4240/wjgs.v3.i4.43

25. Strasberg S.M., Picus D.D., Drebin J.A. Results of a new strategy for reconstruction of biliary injuries having an isolated right-sided component. J. Gastrointest. Surg. 2001; 5 (3): 266–274. https://doi.org/10.1016/s1091-255x(01)80047-0