Management of patients of postcholecystectomy benign biliary stricture complicated by portal hypertension

Agarwal, Anil K.; Gupta, Vishal; Singh, Shivendra; Agarwal, Shaleen; Sakhuja, Puja

doi:10.1016/j.amjsurg.2007.03.013

« Previous Next »The American Journal of Surgery
Volume 195, Issue 4 , Pages 421-426, April 2008

Management of patients of postcholecystectomy benign biliary stricture complicated by portal hypertension

Anil K. Agarwal, M.Ch.
- Department of Gastrointestinal Surgery, Gobind Ballabh Pant Hospital and Maulana Azad Medical College, New Delhi, India
- Corresponding author. Tel.: +091-011-23235702; fax: +091-011-23235702.
Vishal Gupta, M.S.
- Department of Gastrointestinal Surgery, Gobind Ballabh Pant Hospital and Maulana Azad Medical College, New Delhi, India
Shivendra Singh, M.Ch.
- Department of Gastrointestinal Surgery, Gobind Ballabh Pant Hospital and Maulana Azad Medical College, New Delhi, India
Shaleen Agarwal, M.Ch.
- Department of Gastrointestinal Surgery, Gobind Ballabh Pant Hospital and Maulana Azad Medical College, New Delhi, India
Puja Sakhuja, M.D.
- Department of Pathology, Gobind Ballabh Pant Hospital and Maulana Azad Medical College, New Delhi, India

Received 17 January 2007; received in revised form 20 March 2007 published online 28 February 2008.

Abstract

Background

Portal hypertension (PHT) is seen in 15% to 20% of patients with postcholecystectomy benign biliary stricture (BBS). Preliminary portosystemic shunt (PSS) has been recommended to reduce the morbidity and mortality associated with direct stricture repair. Single-center experience of primary repair without preceding PSS in patients of BBS with PHT and a patent portal vein is presented.

Methods

A retrospective study of 13 patients with postcholecystectomy BBS with PHT managed between January 1, 2000 and March 31, 2006.

Results

Roux-en-Y hepaticojejunostomy was performed in 11 patients. There was no major morbidity or mortality with minor complications seen in 3 patients. The median duration of surgery was 3.5 hours with a median blood loss of 300 mL. All patients were asymptomatic at a median follow-up of 17 months.

Conclusion

Hepaticojejunostomy can be performed safely without prior portal decompression in patients with postcholecystectomy BBS complicated by PHT but with a patent portal vein.

Keywords: Biliary stricture, Cholecystectomy, Portal hypertension, Fibrosis