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Benign Bile Duct Strictures

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Abstract

Bile duct strictures can prove to be an extremely difficult diagnostic problem. The majority of Benign bile duct strictures (80%) are unfortunately iatrogenic, the injury occurring after a routine laparoscopic (incidence 0.4-0.6%) or open (incidence 0.2-0.3%) cholecystectomy. The existence of a number of anatomical variations add to the incidence of biliary injury either in isolation or with associated vascular injury. There are also a number of other causes of both iatrogenic and non-iatrogenic causes of benign bile duct strictures. Improved imaging modalities have aided the recognition of the anatomical extent of the stricture and in planning the treatment. Classification of bile duct injury was described by Bismuth in 1982, further modifications were described by Strasberg in 1995. Associated vascular injuries were classified both by Stewart-Way and Bektas et al in the Hannover Classification in 2007. Treatment of biliary stricture depends on the time of diagnosis and type of final injury. While surgery provides the mainstay of treatment, certain select conditions may lend themselves to endoscopic therapy and interventional therapy.

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References

  1. Moser AJ. Benign biliary strictures (2001) Curr treat. Options Gastroenterol 4:377–387

  2. Deziel DJ, Millikan KW, Economou SG et al (1993) Complications of laparoscopic cholecystectomy: a national survey of 4,292 hospitals and an analysis of 77,604 cases. Am J Surg Jan 165(1):9–14

    Article  CAS  Google Scholar 

  3. U.S. Dadhwal, Vipon Kumar (2012) Benign bile duct strictures Med J Armed Forces India. Jul; 68(3): 299–303

  4. Davidoff AM et al. Mechanisms of major biliary injury during laparoscopic cholecystectomy (1992) Ann Surg. Mar;215(3):196–202

  5. Strasberg SM, W. Scott Helton (2011) An analytical review of VBIs in laparoscopic and open cholecystectomy. HPB 13:1–14

  6. Alves A, Farges O, Nicolet J, Watrin T, Sauvanet A, Belghiti J (2003) Incidence and consequence of an hepatic artery injury in patients with postcholecystectomy bile duct strictures. Ann Surg 238:93–96

    PubMed  PubMed Central  Google Scholar 

  7. Koffron A, Ferrario M, Parsons W et al (2001) Failed primary management of iatrogenic biliary injury: incidence and significance of concomitant hepatic arterial disruption. Surgery. 130:722–728

    Article  CAS  Google Scholar 

  8. Sundaram V, Jones DT, Shah NH, de Vera ME, Fontes P, Marsh JW, Humar A, Ahmad J (2011) Post transplant biliary complications in the pre- and post-model for the end-stage liver disease era. Liver Transpl 17(4):428–435

    Article  Google Scholar 

  9. Hohn D, Melnick J, Stagg R et al (1985) Biliary sclerosis in patients receiving hepatic arterial infusions of floxuridine. Clin Oncol 3(1):98–102

    CAS  Google Scholar 

  10. Ngo D, Jia JB, Green CS, Gulati AT, Lall C (2015) Cancer therapy related complications in the liver, pancreas, and biliary system: an imaging perspective. Insights Imaging 6(6):665–677

    Article  Google Scholar 

  11. Shanbhogue AKP, Tirumani SH, Prasad SR et al (2011) Benign biliary strictures: a current comprehensive clinical and imaging review. Gastrointestinal Imaging AJR 197(2):295–306

    Google Scholar 

  12. Singh SM, Reber HA (1990) The pathology of chronic pancreatitis. World J Surg Jan-Feb 14(1):2–10

    Article  CAS  Google Scholar 

  13. Lindor KD, Kowdley KV, Harrison ME (2015) American College of Gastroenterology clinical guideline: primary sclerosing cholangitis. Am J Gastroenterol May 110(5):646–659 Quiz 660

    Article  CAS  Google Scholar 

  14. Sarkar S, Bowlus CL (2016) Primary sclerosing cholangitis: multiple phenotypes, multiple approaches. Clin Liver Dis. Feb. 20(1):67–77

  15. Culver EL, Barnes E (2017) IgG4-related sclerosing cholangitis. Clinical Liver Disease 10:9–16

    Article  Google Scholar 

  16. H. M. Moutsopoulos, G. E. Fragoulis and J. H. Stone (2013) Overview of IgG4-related disease, http://www.uptodate.com/contents/overview-of-igg4-related-disease

  17. D. Joshi and G. J. M. Webster (2014) “IgG4 related sclerosing cholangitis,” Advances in Hepatology, Article ID 632320, 2014–2021

  18. Benhamou Y, Caumes E, Gerosa Y, et al (1993) AIDS-related cholangiopathy. Critical analysis of a prospective series of 26 patients. Dig Dis Sci.38(6):1113

  19. Chattopadhyay S, Nundy S (2012) Portal biliopathy. World J Gastroenterol 18(43):6177–6182

    Article  Google Scholar 

  20. Sarawagi R, Sundar S, Raghuvanshi S, Gupta SK, Jayaraman G (2016) Common and uncommon anatomical variants of intrahepatic bile ducts in magnetic resonance cholangiopancreatography and its clinical implication. Pol J Radiol 81:250–255

    Article  Google Scholar 

  21. Kanda H, Nimura Y, Yasui A, Uematsu T, Kamiya S, Machiki Y, Kitagawa Y, Shionoya S (1996) Hepatic blood flow after acute biliary obstruction and drainage in conscious dogs. Hepatogastroenterology 43:235–240

    CAS  PubMed  Google Scholar 

  22. Stewart L, Domingez CO, Way LW. (2007) Bile duct injuries during laparoscopic cholecystectomy: a sensemaking analysis of operative reports. Mosier K, Fischer U, editors. Proceedings of the 8th International NDM Conference; 2007 Jun; Pacific Grove, CA: [publisher unknown]

  23. Bektas H, Schrem H, Winny M, Klempnauer J (2007) Surgical treatment and outcome of iatrogenic bile duct lesions after cholecystectomy and the impact of different clinical classification systems. Br J Surg.94:1119–1127

  24. Sell S (2001) Heterogeneity and plasticity of hepatocyte lineage cells. Hepatology 33:738–750

    Article  CAS  Google Scholar 

  25. Nathanson MH, Burgstahler AD, Mennone A, Boyer JL (1996) Characterization of cytosolic Ca2+ signalling in rat bile duct epithelia. Am J Phys 271:G86–G96

    CAS  Google Scholar 

  26. LeSage GD, Marucci L, Alvaro D et al (2002) Insulin inhibits secretin-induced ductal secretin by activation of PKC and inhibition of PKA activity. Hepatology. 36:641–651

    Article  CAS  Google Scholar 

  27. Colle I, Van Vlierberghe H, Troisi R, De Hemptinne B (2004) Transplanted liver: consequences of denervation for liver functions. Anat Rec A Discov Mol Cell Evol Biol 280:924–931

    Article  Google Scholar 

  28. Strazzabosco M, Fabris L (2008) Functional anatomy of normal bile ducts. Anat Rec (Hoboken) 291(6):653–660

    Article  Google Scholar 

  29. Blackbourne LH, Earnhardt RC, Sistrom CL, Abbitt P, Jones RS (1994) The sensitivity and role of ultrasound in the evaluation of biliary obstruction. Am Surg 60:683–690

    CAS  PubMed  Google Scholar 

  30. Kim MJ, Mitchell DG, Ito K, Outwater EK (2000) Biliary dilatation: differentiation of benign from malignant causes—value of adding conventional MR imaging to MR Cholangiopancreatography. Radiology 214:173–181

    Article  CAS  Google Scholar 

  31. Materne R, Van Beers BE, Gigot JF et al (2000) Extrahepatic biliary obstruction: magnetic resonance imaging compared with endoscopic ultrasonography. Endoscopy 32:3–9

    Article  CAS  Google Scholar 

  32. Cui Y, Zhang H, Cui N, Li Z (2012) Surgical treatment for benign biliary strictures: single-center experience on 64 cases. EXCLI J 11:390–398

    PubMed  PubMed Central  Google Scholar 

  33. De Wit LT, Rauws EA, Gouma DJ (1999) Surgical management of iatrogenic bile duct injury. Scand J Gastroenterol Suppl. 230():89-94

  34. Ahmad F, Saunders RN, Lloyd GM et al (2007) An algorithm for the management of bile leak following laparoscopic cholecystectomy. Ann R Coll Surg Engl 89(1):51–56

    Article  CAS  Google Scholar 

  35. Schmidt SC, Settmacher U, Langrehr JM, Neuhaus P (2004) Management and outcome of patients with combined bile duct and hepatic arterial injuries after laparoscopic cholecystectomy. Surgery.135:613–618

  36. Koffron A, Ferrario M, Parsons W, et al (2001) Failed primary management of iatrogenic biliary injury: incidence and significance of concomitant hepatic arterial disruption. Surgery.130:722–728; discussion 728-731

  37. Castaing D (2008) Surgical anatomy of the biliary tract. HPB (Oxford) 10(2):72–76

    Article  Google Scholar 

  38. Al-Ghnaniem R, Benjamin IS (2002 Sep) Long-term outcome of hepaticojejunostomy with routine access loop formation following iatrogenic bile duct injury. Br J Surg 89(9):1118–1124

    Article  CAS  Google Scholar 

  39. Barrow PJ, Siriwardena AK (2007) Outcome of hepaticojejunostomy without access loop for repair of iatrogenic bile duct injury at laparoscopic cholecystectomy. J Hepato-Biliary-Pancreat Surg 14(4):374–376

    Article  Google Scholar 

  40. Jayasundara JASB, de Silva WMM, Pathirana AA (2010) Therapeutic value and outcome of gastric access loops created during hepaticojejunostomy for iatrogenic bile duct injuries. Surgeon 8(6):325–329

    Article  CAS  Google Scholar 

  41. Williams HJ Jr, Bender CE, May GR (1987) Benign postoperative biliary strictures: dilation with fluoroscopic guidance. Radiology 163:629–634

    Article  Google Scholar 

  42. Costamagna G, Boškoski I (2013) Current treatment of benign biliary strictures. Ann Gastroenterol 26:37–40

    PubMed  PubMed Central  Google Scholar 

  43. Johannes M.L ,Grant R.W, Stuart J.K et al (2016) Percutaneous management of benign biliary strictures with large-bore catheters: comparison between patients with and without orthotopic liver transplantation JVIR 27, (2,0 pages 219–225

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  1. Department of General and GI Surgery, Calcutta Medical Research Institute, 7/2 Diamond Harbour Road, Kolkata, 700029, West Bengal, India

    Sanjay De Bakshi

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  1. Sanjay De Bakshi
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De Bakshi, S. Benign Bile Duct Strictures. Indian J Surg 83 (Suppl 3), 709–718 (2021). https://doi.org/10.1007/s12262-019-02060-6

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