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2005, Number 1

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Cir Gen 2005; 27 (1)

Benign biliary stenoses. Surgical treatment

Valderrama-Landaeta JL, Al-Awad A, Marcano E, Arias-Fuenmayor E, Chow-Lee G

Language: Spanish
References: 19
Page: 47-51
PDF size: 51.25 Kb.


ABSTRACT

Objective:To present the experience in the management of benign biliary stenoses through surgery and long term follow-up.
Setting:Third level health care center. University hospital of Maracaibo, Maracaibo, State of Zulia, Venezuela.
Patients and methods:Retrospective, descriptive study in 56 consecutive patients with benign biliary stenosis treated surgically, in a 10 year period from 1990 to 2000.
Results:Women predominated with 40 cases (71%). The age group between 41 and 60 years represented the largest number of cases with 22 patients (39%). Diagnoses were: iatrogenic lesions of the biliary ducts, 32 cases (57%); post-bili-enteric shunt stenoses, 15 (27%); traumatic lesions, 6 (7%); and cysts of the choledochus 3 (5%). According to the classification of Bismuth, 29 cases (60%) were type I, 16 (29%) type II, 6 (11%) type III, 4 (7%) type IV, and 1 type V. The hepatic-jejunum anastomosis and the Hepp-Couinaud procedure were the most used ones, 18 cases each. Morbidity was present in 18 patients, no deaths occurred, and the largest percentage of stenoses was found in the choledochus-duodenum anastomoses with 29%, followed by the Hepp-Couinaud procedure (17%), and finally the hepatic-jejunum anastomosis with 5%.
Conclusion:The hepatic-jejunum anastomosis could be used safely in patients with dilated biliary ducts, and the Hepp-Couinaud procedure is a surgical option in patients with risk factors for re-stenosis, and the Winckle loop could be considered as the best reconstruction procedure.


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