Surgical management of strictures of the major bile ducts in recurrent pyogenic cholangitis

Abstract

Definitive surgical procedures were performed on 46 patients with strictures of the major bile ducts: dilatation of strictures was undertaken in 6 patients, hepatotomy and plastic repair in 2, biliary-enteric anastomosis in 18, and liver resection with or without drainage for the rest of the biliary tree in 20 patients. The overall operative morbidity was 21.7 per cent. Two patients died within 30 days of operation. One patient died of septicaemia after emergency dilatation of stricture while another died of sepsis from a leakage after hepatotomy and plastic repair. The median follow-up for the 44 patients who survived the operation was 43 months. All strictures reformed after dilatation within 2 months. Acute cholangitis occurred in six patients, two after dilatation of strictures (with documented recurrent stone formation in one), two after biliary-enteric anastomosis and two after liver resection. Thus, good clinical results were obtained in 38 out of 44 patients (86.4 per cent).