Iatrogenic biliary strictures: surgical experience with 39 patients.

The authors report their experience with surgical treatment of 39 patients with biliary strictures of iatrogenic origin. Patients were grouped according to the level of obstruction as described by Bismuth, and the type of repair was based on this classification. A total of 45 operations were performed, including those for recurrent strictures: 22 hepaticojejunostomies, 10 Hepp and Couinad's operations, 6 choledochojejunostomies, 3 separate right and left hepaticojejunostomies, 1 hepaticojejunostomy with mucosal graft (Smith's technique), 1 intrahepatic cholangiojejunostomy (Longmire's technique), 1 choledochoduodenostomy and 1 choledochoplasty. Results were considered good if the patient was free of symptoms, jaundice or episodes of cholangitis, with serum alkaline phosphatase less than two-times the normal value. Minimum follow-up period of two years (obtained in 35 patients) was required to evaluate the results. Good results were obtained in 26 of those 30 patients (87%) who underwent only one biliary reconstruction, and in 3 of those 5 (60%) with more than one repair. Overall, 29 patients (83% of those 35) presented good results. The complexity of the surgical treatment of biliary strictures imposes the adoption of measures to prevent lesions to the bile duct. Factors related to the prognosis that must be emphasized are surgeons' individual experience and skills, location of the stricture and diameter of the anastomosis.