Progress in biliary stricture repair.

Abstract

Between 1967 and 1970 inclusive, 119 patients underwent 158 operations for the relief of benign bile duct stricture. During this time hepaticojejunostomy was favored for biliary reconstruction, since eighty procedures were of this type. Thirty-eight were end to end repairs and the remainder were a variety of other types. Of the cases evaluated, 58 per cent of the hepaticojejunostomies and 61 per cent of the end to end repairs produced satisfactory results. This experience is an improvement over a previously reported earlier series from this institution. Only three patientd died postoperatively, a significant reduction over an earlier mortality. Further experience with the use of the modified Y tube has been gained in forty-two cases, and it suggests that the benefits might be statistically significant in hepaticojejunostomy if the number of cases were increased. We have begun to evaluate the transhepatic circle tube which can be replaced, when obstructed, on an outpatient basis, thus allowing longer use of stents. Analysis of obstructive biliary sludge in five stents suggests that the sludge is a polymer of bile pigment that is insoluble in both aqueous and organic solutions and therfore not preventable or dissolvable by the administration of chenodeoxycholic acid.