Back to 2018 Posters

---

INCIDENCE, TREATMENT AND OUTCOME OF BENIGN BILIARY STRICTURES AFTER HEPATICOJEJUNOSTOMY
Kengo Fukuoka^*, Minoru Esaki, Toshimitsu Iwasaki, Satoshi Nara, Yoji Kishi, Kazuaki Shimada
Hepatobiliary and pancreatic surgery, National cancer center hospital, Chuo-ku, Tokyo, Japan
Background: Benign biliary stricture (BBS) after hepaticojejunostomy (HJ) is one of the most important and sometimes troublesome late complication. There are few reports regarding this late complication. The purposes of this study were to clarify the treatment of BBS after HJ and outcome in our hospital.
Patients and methods: Patients with BBS, which required biliary drainage for obstructive jaundice or continuous hyperphosphatasemia (>1,000 IU/L) or repeating ascending cholangitis after pancreaticoduodenectomy (PD) and surgery for perihilar cholangiocarcinoma (Hilar) from January 2000 to December 2015 were enrolled. During this period, postoperative BBS were treated in the following order, 1) long term (3-24 months in principle) stenting (LTS), 2) balloon dilation (BD), 3) metal stent or re-HJ. Perioperative factors, methods of treatment for BBS and outcome were retrospectively analyzed.
Results: There were 1403 patients who underwent HJ (PD: n=1108, Hilar: n=295) and 38 patients developed BBS (PD: 26/1108 (2.3%), Hilar: 12/295 (4.1%)). In 38 patients, 25 patients (66%) were male and median age at the time of HJ was 67 years old (range, 44-81 years old). Surgical indications were as follows: IPMN (n=14, 37%), bile duct cancer (n=10, 26%), pancreatic ductal cancer (n=4, 11%), duodenal adenocarcinoma (n=4, 11%), benign tumor (n=2, 6%), others (n=2, 6%). Five patients (13%) were managed with preoperative biliary decompression and remaining 33 cases were not required preoperative biliary drainage. Methods of silastic stent placed intraoperatively in the HJ were lost-stent type (n=11, 29%) and external drainage type (n=27, 71%). Postoperative factors associated with BBS were 4 HJ anastomotic failure (11%), 3 postoperative cholangitis (8%) and 11 postoperative pancreatic fistula (44% of 26 patients who underwent PD). The median period from the surgery to the diagnosis of biliary stricture was 532 days (range, 100-3078 days). Two cases (5%) were cured with only lithotripsy. Only LTS (120-3329 days; median 815 days) via percutaneous transhepatic route in 7 cases and LTS followed by BD (24-1623 days; median 193 days) in 19 cases resulted in biliary stent removal successfully. Metal stents were used in 2 cases (misdiagnosis of recurrence, primary lung cancer development) and re-HJ were performed in 8 cases (6 cases of balloon dilatation failure, 2 cases of stent internalization failure). The median period from biliary drainage to re-HJ was 423 days (range, 20-2073 days). The median follow up period without recurrence of biliary stricture after treatment for BBS was 1337 days (range, 27-2443 days).
Conclusions: BBS after HJ can be managed with LTS via percutaneous transhepatic route and BD in most cases (30 cases, 79%). Optimal indication of re-HJ should be established because some cases required long period of tube stent.

---

Back to 2018 Posters