[Skip to Content]
Sign In
Individual Sign In
Create an Account
Institutional Sign In
OpenAthens Shibboleth
[Skip to Content Landing]
Article
September 1992

Management of Bile Duct StricturesAn Evolving Strategy

Author Affiliations

From the Department of Surgery, UCLA School of Medicine, Los Angeles, Calif. Dr Roslyn is now with the Department of Surgery, Medical College of Pennsylvania, Pa.

Arch Surg. 1992;127(9):1077-1084. doi:10.1001/archsurg.1992.01420090085012
Abstract

• In an effort to determine the role of interventional radiologic and endoscopic techniques in the management of benign biliary strictures, a retrospective analysis was carried out on 194 consecutive patients with bile duct strictures treated at UCLA between 1955 and 1990. Patients were classified as group 1 (1955 through 1979; n=138) or group 2 (1980 through 1989; n=56). Follow-up was for a minimum of 24 months and was in excess of 3 years in 179 patients (92%). Although the incidence of recurrent strictures was similar in the two groups (21% and 23%), the reoperation rate was significantly lower (P<.02) in group 2 (6%) than in group 1 (21 %). Percutaneous transhepatic biliary dilatation, used in 20 patients in group 2, was successful in 13 (93%) of 14 patients with anastomotic strictures and three (50%) of six patients with primary strictures (P<.05). We conclude that surgical reconstruction remains the standard therapy for patients with primary bile duct strictures. Percutaneous transhepatic biliary dilatation has limited usefulness for these patients, but may be more appropriate for those with anastomotic strictures.

(Arch Surg. 1992;127:1077-1084)

References
1.
Longmire WP.  Early management of injury to the extrahepatic biliary tract . JAMA . 1966;195:111-113.Article
2.
Way LW, Dumphy JE.  Biliary stricture . Am J Surg . 1972;124:287-295.Article
3.
Dowsett JF, Vaira D, Hatfield AR, et al.  Endoscopic biliary therapy using the combined percutaneous and endoscopic technique . Gastroenterology . 1989;96:1180-1186.
4.
Williams HJ Jr, Bender CE, May GR.  Benign postoperative biliary strictures: dilation with fluoroscopic guidance . Radiology . 1987;163:629-634.Article
5.
Gallecher DJ, Kadir S, Kaufman SL, et al.  Nonoperative management of benign postoperative biliary strictures . Radiology . 1985;156:625-629.Article
6.
Mueller PR, van Sonnenberg E, Ferrucci JT Jr, et al.  Biliary stricture dilatation: multicenter review of clinical management in 73 patients . Radiology . 1986;160:17-22.Article
7.
Moore AV, Illescas FF, Mills DSR, et al.  Percutaneous dilation of benign biliary strictures . Radiology . 1987;163:625-628.Article
8.
Morrison MC, Lee MJ, Saini A, Brink JA, Mueller PR.  Percutaneous balloon dilatation of benign biliary strictures . Radiol Clin North Am . 1990;28: 1191-1201.
9.
Pitt HA, Kaufman SL, Coleman J, White RI, Cameron JL.  Benign postoperative biliary strictures: operate or dilate . Ann Surg . 1989;210:417-427.Article
10.
Pitt HA, Miyamoto T, Parapatis SK, Tompkins RK, Longmire WP.  Factors influencing outcome in patients with postoperative biliary strictures . Am J Surg . 1982;144:14-21.Article
11.
Burhenne HJ.  Dilatation of biliary tract strictures: a new roentgenologic technique . Radiol Clin . 1975;44:153-159.
12.
Burhenne HJ, Morris DC.  Biliary stricture dilatation: use of the Gruntiz balloon catheter . J Can Assoc Radiol . 1980;31:196-197.
13.
Molnar W, Stockum AE.  Transhepatic dilatation of choledochoenterostomy strictures . Radiology . 1978;129:59-64.Article
14.
Speer AG, Russel RCG, Hatfield ARW, et al.  Randomised trial of endoscopic versus percutaneous stent insertion in malignant obstructive jaundice . Lancet . 1987;2:57-62.Article
15.
Csendes A, Diaz JC, Burdiles P, Maluenda F.  Late results of immediate primary end to end repair in accidental section of the common bile duct . Surg Gynecol Obstet . 1989;168:125-130.
16.
Longmire WP Jr, Tompkins RK.  Lesions of the segmental and lobar hepatic ducts . Ann Surg . 1975;182:478-495.Article
17.
Genest JF, Nonos E, Grundfest-Broniatowski S, Vogt D, Hermann RE.  Benign biliary strictures: an analytic review (1970-1984) . Surgery . 1986;99: 409-413.
18.
Innes JT, Ferrara JJ, Carey LC.  Biliary reconstruction without transanastomotic stent . Am Surg . 1988;54:27-30.
19.
Ross CB, H'Doubler WZ, Sharp KW, Potts JR.  Recent experience with benign biliary strictures . Am Surg . 1989;55:64-70.
20.
Armstrong CP, Dixon JM, Taylor TV, Davies GC.  Surgical experience of deeply jaundiced patients with bile duct obstruction . Br J Surg . 1984;71: 234-238.Article
21.
Pellegrini CA, Thomas MJ, Way LW.  Recurrent biliary stricture: patterns of recurrence and outcome of surgical therapy . Am J Surg . 1984;147: 175-180.Article
22.
Peters JH, Gibbons GD, Innes JT, et al.  Complications of laparoscopic cholecystectomy . Surgery . 1991;110:769-777.
23.
 A prospective analysis of 1518 laparoscopic cholecystectomies: the Southern Surgeons Club . N Engl J Med . 1991;324:1073-1078.Article
24.
Ponsky JL.  Complications of laparoscopic cholecystectomy . Am J Surg . 1991;161:393-395.Article
25.
Peters JH, Ellison EC, Innes JT, et al.  Safety and efficacy of laparoscopic cholecystectomy: a prospective analysis of 100 initial patients . Ann Surg . 1991;213:3-12.Article
×