Reconstructive surgery and percutaneous balloon dilation for the treatment of benign biliary strictures: A retrospective study.

Abstract

Background: It is well known that in case of high initial strictures of bile ducts surgical treatment is associated with a high risk of damage to the hepatoduodenal ligament elements, often involved in rough scarring, and with a significant risk of stricture recurrence.

Aim: To compare the long-term outcomes of different surgical treatment options for patients with high-grade benign biliary strictures.

Methods: From 2012 to 2022, 193 patients were treated at the A.V. Vishnevsky Surgical Center. All of them had different levels of strictures according to Bismuth-Strasberg classification: Type E1-2 in 32 patients, type E3 - 99, type E4 - 62.123 patients underwent open reconstructive interventions, 70 percutaneous endobiliary interventions.

Results: Long-term results were available for 192 (99%) patients with a follow-up of 4.7 ± 1.6 years after reconstructive surgery; 3.0 ± 1.4 years after percutaneous interventions. Excellent and good results (according to Terblanche classification) were achieved in 35% (42/122) of patients after open reconstructive surgery and in 13% (9/70) of patients after percutaneous transhepatic interventions (P-value < 0.05).

Conclusion: Technically, the most difficult bile duct strictures for reconstructive and percutaneous transhepatic interventions with a high recurrence rate are Bismuth-Strasberg type E4 and E5. The comparative analysis of long-term results of percutaneous and open procedures showed a statistically significant advantage of percutaneous procedures compared to open reconstructive procedures.