Central-peripheral cholangiojejunostomies for the management of high bile strictures. A 164 personal experience cases.

Abstract

Objective: We present the experience of the author performing
different kinds of cholangiojejunostomies and associated hepatic
resections over hepatic duct and confluence.
Patients and methods: Data analysis from personal experience of
the author filled prospectively, in cholangiojejunostomies over
hepatic duct and confluence between 1988 and 2004, referred
with diagnosis of bile duct strictures to four different institutions:
Servicio de Cirugía II del Hospital Ildemaro Salas (IVSS), Servicio
de Cirugía Digestiva del Hospital Oncológico “Padre Machado”,
Servicio de Cirugía III del Hospital “Domingo Luciani” (IVSS) y al
Instituto de Clínicas y Urología Tamanaco. Patients with low stricture
of the bile duct were excluded.
Results: A 64,4% of this patients with hepatic bile duct strictures
were due to bile duct injuries during cholecystectomy. 33,5%
due to malignant disease. 154 (93,9%) underwent hiliar cholangiojejunostomy
and 10 (6,09%) underwent peripheral cholangiojejunostomy.
We performed 32 hepatic resections, 23 (71,7%)
were minor resections and 9 (28,13%) were major. 95 (57,9%)
biliar surgeries were performed: 90 (94,4%) due to benign dise-ase and 5 (5,2%) due to malignant disease. There was a morbidity
of 21,9% and a mortality of 7,9% . 88,68% with iatrogenic
bile duct strictures showed good outcome. Palliative surgeries
showed good outcome for 10,5 months in 56% and bad outcome
in 44% after three months.
Conclusion: Central and peripheral cholangiojejunostomy as
surgical treatment yields excellent results in patients with HBDS
and offered effective palliation in performance status (PS) compared
with the preoperative PS of this patients.