Long-term follow-up of percutaneous transhepatic biliary drainage (PTBD) in patients with benign bilioenterostomy stricture

Background and aims: Anastomotic strictures are well-known complications after bilioenterostomy. Endoscopic procedures are usually not possible in patients with a bilioenterostomy. Hence, percutaneous transhepatic biliary drainage (PTBD) has become the treatment of choice for the management of these patients. The main goal of the present study was to analyze the long-term follow-up of PTBD in such patients.

Methods and patients: Between January 1996 and December 2006, 44 patients with benign anastomotic stricture after bilioenterostomy were identified by an analysis of the PTBD database, hospital charts, and cholangiograms.

Results: In 27/44 patients the percutaneous transhepatic biliary drain was successfully removed after 19.9 ± 16.1 months (treatment success in 61.4 %). During a mean follow-up of 53.7 ± 28.4 months after removal of the drain, no evidence was found of recurrent strictures in these patients. Ten out of 44 patients carry permanent drains (22.6 % of patients with ongoing treatment, mean follow-up 46.4 ± 54.7 months) without the option for further surgery owing to concomitant disease (n = 2) or because they refused further surgery (n = 8). In 7 out of 44 patients (16 %) PTBD treatment was deemed to have failed and the patients underwent repeat operation.

Conclusions: PTBD should be considered the treatment of choice in patients with benign anastomotic stricture after bilioenterostomy, especially after stricturing of a hepatojejunostomy.

References

• 1 Johnson S R, Koehler A, Pennington L K. et al . Long-term results of surgical repair of bile duct injuries following laparoscopic cholecystectomy.  Surgery. 2000;  128 668-677
• 2 Moraca R J, Lee F T, Ryan J A. et al . Long-term biliary function after reconstruction of major bile duct injuries with hepaticoduodenostomy or hepaticojejunostomy.  Arch Surg. 2002;  137 889-893
• 3 Murr M M, Gigot J F, Nagorney D M. et al . Long-term results of biliary reconstruction after laparoscopic bile duct injuries.  Arch Surg. 1999;  134 604-609
• 4 Al-Ghnaniem R, Benjamin I S. Long-term outcome of hepaticojejunostomy with routine access loop formation following iatrogenic bile duct injury.  Br J Surg. 2002;  89 1118-1124
• 5 Braasch J W, Bolton J S, Rossi R L. A technique of biliary tract reconstruction with complete follow-up in 44 consecutive cases.  Ann Surg. 1981;  194 636-638
• 6 Stefanini P, Carboni M, Patrassi N. et al . Roux-en-Y hepaticojejunostomy: a reappraisal of its indications and results.  Ann Surg. 1975;  181 213-219
• 7 Tocchi A, Costa G, Lepre L. et al . The long-term outcome of hepaticojejunostomy in the treatment of benign bile duct strictures.  Ann Surg. 1996;  224 162-167
• 8 Röthlin M A, Löpfe M, Schlumpf R. et al . Long-term results of hepaticojejunostomy for benign lesions of the bile ducts.  Am J Surg. 1998;  175 22-26
• 9 Pellegrini C A, Thomas M J, Way L W. Recurrent biliary stricture patterns of recurrence and outcome of surgical therapy.  Am J Surg. 1984;  147 175-180
• 10 Schumacher B, Othman T, Jansen M. et al . Long-term follow-up of percutaneous transhepatic therapy (PTT) in patients with definite benign anastomotic strictures after hepaticojejunostomy.  Endoscopy. 2001;  33 409-415
• 11 Kim J H, Lee S K, Kim M H. et al . Percutaneous transhepatic cholangioscopic treatment of patients with benign bilio-enteric anastomotic strictures.  Gastrointest Endosc. 2003;  58 733-738
• 12 Ring E J, Oleaga J A, Freiman D B. et al . Therapeutic applications of catheter cholangiography.  Radiology. 1978;  128 333-338
• 13 Moore A V, Illescas F F, Mills S R. et al . Percutaneous dilation of benign biliary strictures.  Radiology. 1987;  163 625-628
• 14 Bergman J J, Burgemeister L, Bruno M J. et al . Long-term follow-up after biliary stent placement for postoperative bile duct stenosis.  Gastrointest Endosc. 2001;  54 154-161
• 15 Dumonceau J M, Devière J, Delhaye M. et al . Plastic and metal stents for postoperative benign bile duct strictures: the best and the worst.  Gastrointest Endosc. 1998;  47 8-17
• 16 Tocchi A, Mazzoni G, Liotta G. et al . Management of benign biliary strictures: biliary enteric anastomosis vs endoscopic stenting.  Arch Surg. 2000;  135 153-157
• 17 Pitt H A, Miyamoto T, Parapatis S K. et al . Factors influencing outcome in patients with postoperative biliary strictures.  Am J Surg. 1982;  144 14-21
• 18 Blumgart L H, Kelley C J, Benjamin I S. Benign bile duct strictures following cholecystectomy, critical factors in management.  Br J Surg. 1984;  71 836-843
• 19 Vos P M, van Beek E J, Smits N J. et al . Percutaneous balloon dilatation for benign hepaticojejunostomy strictures.  Abdom Imaging. 2000;  25 134-138
• 20 Spahn T W, Grosse-Thie W, Spies P. et al . Treatment of choledocholithiasis following Roux-en-Y hepaticojejunostomy using double-balloon endoscopy.  Digestion. 2007;  75 20-21
• 21 Haruta H, Yamamoto H, Mizuta K. et al . A case of successful enteroscopic balloon dilation for late anastomotic stricture of choledochojejunostomy after living donor liver transplantation.  Liver Transpl. 2005;  11 1608-1610