title: Surgery or endoscopy for treatment of postcholecystectomy bile duct strictures?
abstract: 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.
authors.affiliation: Department of Surgery and Advanced Technologies, University Federico II, School of Medicine, Naples, Italy. gdepalma@arrotino.it
authors.forename: Giovanni D
authors.initials: GD
authors.lastname: De Palma
authors.forename: Giovanni
authors.initials: G
authors.lastname: Persico
authors.forename: Roberto
authors.initials: R
authors.lastname: Sottile
authors.forename: Alessandro
authors.initials: A
authors.lastname: Puzziello
authors.forename: Gianpaolo
authors.initials: G
authors.lastname: Iuliano
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Salvati
authors.forename: Mario
authors.initials: M
authors.lastname: Donisi
authors.forename: Francesco
authors.initials: F
authors.lastname: Persico
authors.forename: Luigi
authors.initials: L
authors.lastname: Mastantuono
authors.forename: Marcello
authors.initials: M
authors.lastname: Persico
authors.forename: Stefania
authors.initials: S
authors.lastname: Masone
mesh_terms: 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