title: Long-term results of hepaticojejunostomy for benign lesions of the bile ducts.
abstract: 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 questionnaire 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 questioned, 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.
authors.affiliation: Department of Surgery, Zürich University Hospital, Switzerland.
authors.forename: M A
authors.initials: MA
authors.lastname: Röthlin
authors.forename: M
authors.initials: M
authors.lastname: Löpfe
authors.forename: R
authors.initials: R
authors.lastname: Schlumpf
authors.forename: F
authors.initials: F
authors.lastname: Largiadèr
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000713:Anastomosis, Roux-en-Y; D001649:Bile Duct Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D002423:Cause of Death; D002758:Cholangiography; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003137:Common Bile Duct Diseases / Q000000981:diagnostic imaging / Q000601:surgery; D003251:Constriction, Pathologic; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D006500:Hepatic Duct, Common / Q000601:surgery*; D006801:Humans; D007049:Iatrogenic Disease; D007583:Jejunum / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000000981:diagnostic imaging / Q000601:surgery*; D011183:Postoperative Complications; D012008:Recurrence; D012189:Retrospective Studies; D013997:Time Factors