Stenosis at the Site of Bile Duct Anastomosis

Abstract

Anastomotic strictures are usually the result of faulty surgical technique or the formation of scar tissue. They occur in 0% [20] to 5% of cases [7, 29]. Whereas in some reports, anastomotic stenoses account for the majority of biliary strictures following liver transplantation [7], our group and other authors found nonanastomotic strictures to be more frequent [23, 26]. Anastomotic strictures may occur mainly inearly postoperative period but may also occur later in the course [38]. The type of anastomosis chosen seems to influence this complication. The highest rate of stenosis was found after choledochojejunostomy [8, 7], the lowest, following side-to-side biliary reconstruction [20, 21]. In our experience, side-to-side anastomosis appeared to have the lowest stricture rate but this result was not statistically significant. Finally, arterial thrombosis of the graft has been reported to be a cause of anastomic strictures. In 2 out of 20 patients with anastomotic strictures, hepatic artery occlusion was found [39]. However, this appears to be coincidental and is rather untypical.