Multifactorial and complex approach to surgical treatment of benign biliary strictures

Abstract

Objective of study was to systematize the experience of treating benign biliary strictures, analyzing the complex results. Materials and methods. The integral prospective and retrospective cohort study analyzed the long-term results of 203 patients who underwent biliodigestive reconstructions during 1989-2015 years. Patients included in the research were supervised during 2-5 years: depending on the local anatomic particularities at the moment of reconstructive surgery, as well the remote clinical-evolutive particularities, using the clinical Terblanche score. Results. The reconstructive surgical treatment was individual and directly proportional with the level of biliary strictures with a preference of selection of biliodigestive derivations on jejunal loop a la Roux. The reconstructive treatment of benign biliary strictures, classified according to Bismuth’s classification, included the following surgical techniques: choledocojejunostomy in 86(42,4%) cases of type I and II strictures; hepaticojejunostomy to 102 (50,2%) patients with type III strictures, and in 15(7,4%) cases of type IV strictures bihepaticojejunostomy was performed. There were determined the following remote results based on the clinical-evolutive classification: very good / gr. I – in 123 (60,6±4,41%) cases, good / gr. II in 39 (19,2±6,31%) cases, relative satisfactory / gr. III – 18 (8,9±6,91%) cases and unsatisfactory / gr. IV in 23 (11,3±6,75%) cases. Conclusions. The surgery of election in biliary strictures is hepaticojejunostomy on Roux loop. Analisis of remote results proved clinical efficiency of reconstructive interventions performed in 88,67% observations.