title: Percutaneous dilatation of biliary strictures through the afferent limb of a modified Roux-en-Y choledochojejunostomy or hepaticojejunostomy.
abstract: BACKGROUND
  This report is a 13-year prospective evaluation of percutaneous balloon dilatation of benign biliary strictures through the subcutaneous or subfascially positioned afferent limb of a choledocho or hepaticojejunostomy in 30 patients.
  
  
  METHODS
  Twenty-seven strictures developed after a common duct injury sustained at the time of cholecystectomy, two after hepatectomy reconstruction for trauma and one following a gastrectomy. Twelve injuries (40%) were recognized at operation. Of the 18 patients where the injury was unrecognized at the time of operation, 8 had not been reoperated at the time of referral, 7 had late repairs by the referring physician, and 3 had late repairs at our institution. The follow-up is 1 to 13 years.
  
  
  RESULTS
  There has been 1 late death and 6 patients are lost alive. The jejunal-limb was accessed 50 times with two minor and no major complications. There have been two parajejunal hernia repairs, but there have not been any reoperations for recurrent biliary strictures.
  
  
  CONCLUSIONS
  Benign biliary strictures can be effectively managed by repeat balloon dilatations thru the afferent limb of a choledocho or hepaticojejunostomy, thus eliminating the need for repeat surgical interventions.
authors.affiliation: Department of Surgery, University of Miami School of Medicine, Florida 33101, USA.
authors.forename: D G
authors.initials: DG
authors.lastname: Hutson
authors.forename: E
authors.initials: E
authors.lastname: Russell
authors.forename: J
authors.initials: J
authors.lastname: Yrizarry
authors.forename: J U
authors.initials: JU
authors.lastname: Levi
authors.forename: A S
authors.initials: AS
authors.lastname: Livingstone
authors.forename: J
authors.initials: J
authors.lastname: Guerra
authors.forename: R
authors.initials: R
authors.lastname: Reddy
authors.forename: L
authors.initials: L
authors.lastname: Jeffers
authors.forename: E R
authors.initials: ER
authors.lastname: Schiff
authors.forename: T
authors.initials: T
authors.lastname: Scagnelli
authors.forename: K
authors.initials: K
authors.lastname: Mendez
mesh_terms: D000328:Adult; D000368:Aged; D000713:Anastomosis, Roux-en-Y; D002404:Catheterization; D002763:Cholecystectomy; D002768:Choledochostomy; D003135:Common Bile Duct / Q000293:injuries; D003251:Constriction, Pathologic; D006801:Humans; D007431:Intraoperative Complications; D007582:Jejunostomy / Q000379:methods*; D008875:Middle Aged