Benign postoperative biliary strictures: dilation with fluoroscopic guidance.

Abstract

Benign postoperative biliary strictures in 74 patients were dilated percutaneously with balloon catheters. In all cases, dilation was performed with fluoroscopic guidance in a radiology suite. Lasting patency following removal of biliary stents occurred in 73% of 49 patients with biliary-enteric anastomotic strictures and in 88% of 25 patients with primary ductal strictures, for an overall success rate of 78%. A successful outcome was more likely if the interval between the last biliary tract surgery and balloon dilation exceeded 2 years. Stricture patency was more easily achieved in patients with primary ductal strictures than in those with biliary-enteric anastomotic strictures. Serious, procedure-related complications were encountered when strictures were dilated transhepatically; these included sepsis in 18 of 65 patients and bleeding due to arteriobiliary communications in seven. No serious complications occurred when strictures were dilated via a T tube track, making this the preferred route if available. Surgeons should be encouraged to leave T tubes in place if postoperative biliary stricture is suspected. Balloon dilation should be strongly considered in patients with benign postoperative strictures in whom surgical repair is difficult.