Preliminary results of surgical repair of iatrogenic biliary strictures

Introduction: Iatrogenic biliary injury remains a critical complication of cholecystectomy, with devastating consequences to the liver and risk of death. Objective: We aimed to evaluate the long-term results of surgical repair of iatrogenic biliary injuries performed at a single center. Methodology: Patients who underwent surgical reconstruction for iatrogenic biliary injury between 1990 and 2016 were retrospectively evaluated. We collected data from medical records and the electronic database HCMED. The preliminary results were analyzed by comparing frequencies or arithmetic means with standard deviations of the recorded parameters. Results: We included 158 cases in the study, 81% of these women and with mean age of 45.54 years. The most common symptoms were jaundice (79.11% of the cases), abdominal pain (59.49%), choluria (52.53%), acholia/hipocholia (47.47%), fever (44.3%), pruritus (34.18%) and weight loss (27.22%). Biliary stricture was secondary to conventional cholecystectomy in 63.92% of the cases, laparoscopic cholecystectomy in 22.15% and non-specified cholecystectomy in 13.92%. We divided patients according to diagnosis of biliary duct stricture (BDS), n=93 cases (58.86%), and bilioenteric anastomosis stricture (BEAS), n=65 cases (41.14%). In BDS group, levels of bilirubin, ALT, AST and GGT were significantly increased pre compared to post surgical repair. In BEAS group, levels of bilirubin, AST and GGT were significantly increased in the preoperative compared to the postoperative, however there were no differences in ALT levels. Recurrence of stricture occurred in 5 cases of BDS group, and 7 cases of BEAS group. Survival in the BDS group was 98.92% in 1 year and 97.85% in 5 years, and in BEAS group, 98.64% and 95.38%, respectively. Conclusions: Surgical repair of complex biliary stricture can achieve long-term success in 89.87% of patients when performed in reference services.