Surgery or endoscopy for treatment of postcholecystectomy bile duct strictures?
BACKGROUND
Surgery is considered the treatment of choice for postoperative biliary strictures. Recently, endoscopic stent placement has been proposed as an alternative to surgical management in selected patients.


METHODS
In this retrospective study, 157 patients with postoperative biliary strictures were included. Eighty patients (group A) were treated endoscopically and 77 by surgery (group B). Baseline characteristics of patients were comparable in both groups. Endoscopic therapy consisted of placement of endoprostheses, with trimonthly elective exchange for a 1-year period. Surgical therapy consisted of constructing a biliary-digestive anastomosis in normal ductal tissue. Data were evaluated according to intention-to treat analysis.


RESULTS
Successful treatment was achieved in 54% of group A and 73% of group B (P <0.001). Overall 31% of patients developed complications in group A and 23% of patients in group B (P <0.05). However, the rates of severe complications were comparable in both groups (11% versus 13%; P = not significant) In group A the mortality rate was 0% compared with 8% of group B (P <0.05). Recurrent stenosis was evidenced in 6% of patients of group A and 5% of patients of group B.


CONCLUSIONS
Surgery provides a better long-term outcome over the endoscopy, because of patients with total obstruction are not amenable to endoscopic approach. When successfully done, endoscopic results are similar to surgical results with less mortality.
De Palma
Giovanni D
GD
Department of Surgery and Advanced Technologies, University Federico II, School of Medicine, Naples, Italy. gdepalma@arrotino.it
Persico
Giovanni
G
Sottile
Roberto
R
Puzziello
Alessandro
A
Iuliano
Gianpaolo
G
Salvati
Vincenzo
V
Donisi
Mario
M
Persico
Francesco
F
Mastantuono
Luigi
L
Persico
Marcello
M
Masone
Stefania
S
D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D002763:Cholecystectomy / Q000009:adverse effects*; D001651:Cholestasis, Extrahepatic / Q000209:etiology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery*; D012189:Retrospective Studies; D055502:Secondary Prevention; D015607:Stents; D016896:Treatment Outcome