ABSTRACT
There are many factors to consider when treating a patient with a bile duct injury or benign biliary stricture. There are many causes of biliary stricture (Table 19.1), but most bile duct injuries or strictures occur as a result of cholecystectomy for symptomatic gallstone disease. The majority of these patients are young (40-50 years), female, have a long
life expectancy, and are in the most productive years of their life. Because of this, it is
Table 19.1 Causes of biliary stricture
Postoperative bile duct injury or stricture • Biliary surgical procedures: Cholecystectomy Common bile duct exploration Biliary-enteric anastomoses (especially with normal-sized ducts) • Other abdominal procedures: Gastrectomy Pancreatic operations Hepatectorny Portacaval shunt or other portal vein procedures Traumatic bile duct injury • Following blunt penetrating trauma Inflammatory • Chronic pancreatitis • Gallstones and recurrent cholangitis • Subhepatic abscess, liver abscess • Parasitic infections Other • Primary sclerosing cholangitis • Radiation fibrosis • Duodenal diverticulum • Papillary stenosis • Chronic duodenal ulcer
essential that these patients have prompt recognition of their problem and a reliable treatment with a long-term success rate. Unlike malignant strictures, treatment durability is an essential factor in determining treatment success for benign biliary strictures.
