Il posizionamento di protesi biliari per stenosi biliari benigne post-operatorie.


COD: 019-026 Categorie: ,

Carmelo Sciumè, Girolamo Geraci, Franco Pisello, Tiziana Facella, Francesco Li Volsi, Giuseppe Modica

Ann. Ital. Chir., 2006; 77: 19-25

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OBJECTIVE: To describe the management and outcome after endoscopic treatment of 23 patients with post-operative benign
bile duct stricture (BBDS) managed in Authors’ Department from 1991 to 2000.
BACKGROUND DATA: The management of the postoperative bile duct strictures remains a challenge for even the most skilled
biliary tract surgeon and endoscopist. The 1990s saw a dramatic increase in the incidence of bile duct strictures
from the introduction and widespread use of laparoscopic cholecystectomy. The management of these injuries, short-term
outcome and follow-up have been reported.
METHODS: Data were collected retrospectively on 23 patients treated in the Service of Diagnostic and Operative Endoscopy
of the Operative Unit of General and Thoracic Surgery (Policlinico “Paolo Giaccone”, Palermo, Italy) with BBDS between
1991 and 2000. All patients underwent ERCP (endoscopic retrograde cholangiopancreatography). Follow-up and pharmacological
therapy post-ERCP were conducted by scheduled medical audit.
RESULTS: Of the 23 initial patients, 20 undergoing endoscopic stenting (3 with complete transaction were invited to surgery),
16 had completed treatment with symptoms resolution (mean follow-up of 70 months). One patient died of reason
unrelated to biliary tract disease before the completion of treatment. Seven had not completed treatment. Of 16
patient who had completed treatment, 13 were considered to have a successful outcome without the need of follow-up
invasive, diagnostic or therapeutic interventional procedures. Overall, a successful outcome, was obtained in 65% of
patients, including those requiring a secondary procedure for recurrent strictures.
CONCLUSIONS: Postoperative bile duct strictures remain a considerable surgical challenge. Management with endoscopic
cholangiography to delineate the postoperative anatomy and to place biliary stents, to solve the symptoms, is associated
with a successful outcome in up of 65% of patients, in well experienced team. Endoscopic treatment should be the initial
management of choice for postoperative bile duct stenosis, as a real alternative to surgical reconstruction: because his
failure will not compromised the following surgical treatment prior endoscopic treatment does not preclude surgery),
whereas endoscopic treatment is impossible one a Roux-en-Y loop has been constructed.


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