Tratamento cirúrgico das estenoses da via biliar

BACKGROUND: Benign stricture of biliary tract (BSBT) are iatrogenic in about 95% of the cases. Although rare, its outcome is poor; therefore prevention is the best option. The objective of this study is to evaluate the surgical management and its results in BSBT. METHODS: We retrospectively analyzed 11 patients submitted to corrective surgery for BSBT at Hospital Universitario Regional do Norte do Parana, from July / 92 to December / 01. RESULTS: There were nine female patients and the mean age was 43.71 years old. Previous surgeries were classic cholecistectomies (81.8%) and videocholescistectomies (18.2%).The most frequent signs and symptoms were jaundice (64.3%), abdominal pain (64.3%) and fever (21.4). The diagnosis was confirmed by CPRE in 90.9% of the patients and CTP in 9.1%. According to Bismuth‘s classification, 18.2% of the patients were considered grade I, 45.4% grade II, 18.2% grade III and 18.2% grade IV. The corrective surgery for BSBT was choledochoduodenostomy in two cases of grade I, hepaticojejunostomy using a Roux-en-Y loop of jejunum in five cases of grade II, Hepp-Couinaud's operations in two cases of grade III, hepaticojejunostomy with mucosal graft (Smith's technique) in two cases of grade IV. The postoperative complications were fistula (18.2%), death (18.2%), pneumonia (9.1%) and hemobilia (9.1%). CONCLUSION: Complexity of the surgical treatment requires prevention of injuries. Bile duct lesions repair should be considered as a specialist's procedure and should be performed in a center with special interest in this disease.