Balloon dilatation of benign postsurgical biliary-enteric anastomotic strictures

Balloon Catheter Dilatation of Stenotic Common Bile Duct Anastomoses in the Pig

Fibrotic stenosing anastomoses of the common bile duct were surgically created in pigs in order to investigate the effects of percutaneous transhepatic balloon catheter dilatation. In a group of 6 animals, not treated with balloon dilatation, percutaneous transhepatic cholangiography and microscopic examination of the stricture were performed 5 to 25 weeks postoperatively. A persistent stenosis and slight to moderate fibrosis of the bile duct wall and peribiliary tissue were observed. In 5 animals the stenotic anastomosis was dilated.4 to 10 weeks postoperatively and this resulted in widening of the stricture and necrosis of the mucosa at the stricture site. Rupture of the fibrotic tissue in the bile duct wall and thrombus formation in the peribiliary veins also occurred in one of these 5 animals. Short-term follow-up in 3 animals 4 to 6 weeks after balloon dilatation showed almost complete fibrotic healing and partial re-stenosis of the anastomoses.

Dilatation of intrahepatic biliary strictures in patients with hepatolithiasis

To investigate the role of balloon dilatation in the management of complicated hepatolithiasis with intrahepatic biliary stricture, 57 consecutive patients who received 208 sessions of dilatation in addition to the usual treatment were analyzed. The strictures were located in the right intrahepatic ducts (84.2%), left intrahepatic ducts (12.3%), or both (3.5%). Dilatation began 3-4 weeks after surgery. The routes of dilatation included the matured T-tube tract (3 cases), percutaneous transhepatic biliary drainage tracts (42 cases), and both (12 cases). The immediate overall success rate of complete stone clearance increased significantly from 0% predilatation to 94.7% postdilatation. The main complications of dilatation therapy consisted of septicemia (10.5%), hemobilia (10.5%), and mild diarrhea (80%). Eight patients (14%) with long-segment strictures received 11 postdilatation biliary stentings. Complications were 1 patient with occlusion and 2 patients with "spontaneous" hemobilia. Severe multiple strictures and coexistent secondary biliary cirrhosis were the contributing factors to complications. During the follow-up of 3.4 +/- 1.2 years, recurrence of strictures was found in 4 patients. Two of them belonged to the stenting group. The cumulative probability of restricture was low: 4% at 2 years, 6% at 2.5 years, and 8% at 3 years. We conclude that in complicated cases of hepatolithiasis with intrahepatic biliary stricture, dilatation and stenting are good adjuvant therapies.

Reconstruction of the biliary tract

The history of biliary reconstruction is a record of almost 100 years of surgical advancement. A reasonable technique is now available and applies not only to reconstruction after injury in the course of cholecystectomy but also to reconstruction after resection of tumor or in the treatment of sclerosing cholangitis, choledochocyst, or biliary calculi. A successful technique requires a dissection that does not compromise blood supply to the proximal duct, the use of a single layer of interrupted sutures, the temporary placement of a stent, and the use of bowel at the hilus of the liver without tension. As in most operative procedures the actual performance of the reconstruction is relatively easy in slender, good surgical subjects, but operative decisions and the actual technique used in locating the proximal duct and in suturing deep in the right upper quadrant can make reconstruction a difficult procedure.

Interventional radiology of the biliary system and pancreas

In recent years, newer techniques have become available to the clinician for the diagnosis and treatment of biliary and pancreatic disease. This article emphasizes interventional procedures through the liver, such as percutaneous transhepatic cholangiography, percutaneous transhepatic biliary drainage, and ancillary techniques. Also discussed are the nonsurgical management of bile duct calculi and the diagnosis and treatment of pancreatic tumors, abscesses, and pseudocysts.