Long-term results of hepaticojejunostomy for benign lesions of the bile ducts

BACKGROUND: Hepaticojejunostomy has been the method of choice for the treatment of benign lesions of the extrahepatic bile ducts for years, In the era of minimally invasive and interventional techniques, a review of its long-term results is necessary to set the standard with which these new techniques have to be compared, METHODS: A retrospective analysis was carried out for 51 patients (16 females, 35 males) aged 24 to 83 years (average 48 +/- 13) who had undergone hepaticojejunostomy for benign lesions at our institution between 1980 and 1989, Twelve patients had had up to 4 prior operations of their bile ducts, The main indications for operation were chronic pancreatitis (n = 33) and iatrogenic bile duct lesions (n = 15). If possible, a low end-to-side hepaticojejunostomy was performed, The Hepp-Couinaud approach was saved for high strictures and recurrences, All patients were reassessed by questionaire at an average of 7.6 years (range 2 to 13) after the operation, RESULTS: Four Hepp-Couinaud and 47 low hepaticojejunostomies were performed, Postoperative complications were seen in 17 patients (33%), 4 of whom had a reoperation, One patient died, for a mortality rate of 2%, The hospital stay averaged 24 +/- 17 days (range 8 to 90), Late complications developed in 13 patients (25%) 2 months to 6 years after the operation, Stenosis and cholangitis necessitated reoperation in 3 cases, cholangitis without stenosis was treated in 4, and other complications were seen in 5 cases, One patient died with a liver abscess, and 12 died of causes unrelated to the operation. When questionned, 31 of 35 patients were in good or very good condition, CONCLUSIONS: Hepaticojejunostomy is a safe and reliable method for the treatment of benign lesions of the bile ducts even in young patients in need of a long-term biliary bypass. (C) 1998 by Excerpta Medica, Inc.