Combined surgical and interventional radiological approach for complex benign biliary tract obstruction

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  • W P Schweizer
    Department of Visceral and Transplantation Surgery, University of Berne, Switzerland
  • J B Matthews
    Department of Visceral and Transplantation Surgery, University of Berne, Switzerland
  • H U Baer
    Department of Visceral and Transplantation Surgery, University of Berne, Switzerland
  • L I Nudelmann
    Department of Visceral and Transplantation Surgery, University of Berne, Switzerland
  • J Triller
    Department of Radiology, University of Berne, Switzerland
  • F Halter
    Gastrointestinal Unit, University of Berne, Switzerland
  • P Gertsch
    Department of Visceral and Transplantation Surgery, University of Berne, Switzerland
  • L H Blumgart
    Department of Visceral and Transplantation Surgery, University of Berne, Switzerland

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<jats:title>Abstract</jats:title> <jats:p>In patients with complicated high benign biliary strictures surgical technique alone cannot exclude the possibility of recurrent problems, and hepatic atrophy/hypertrophy, portal hypertension and intrahepatic stones may all complicate surgical management. A multidisciplinary approach to these complex cases, which minimizes the need for repeated surgical interventions, has been pursued. Roux-en-Y hepaticojejunostomy was performed and an extended limb of the jejunum brought to the abdominal wall to allow access for later radiological intervention. Over a 30-month period 58 biliary-enteric anastomoses for benign disease were performed. Seventeen of these 58 patients were managed using the combined approach. Ten of these 17 patients had complex postcholecystectomy strictures and seven had strictures resulting from inflammatory disease, hepatic resection or congenital problems. A new classification of results of management of bile duct strictures is proposed. Seven patients were classified as ‘excellent’, six ‘good’, two ‘fair’ and two ‘poor’. Results were obtained at a mean follow-up of 16 months and it seems likely that in some patients major surgical reinterventions were avoided.</jats:p>

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