Post-cholecystectomy benign biliary stricture with portal hypertension: is a portosystemic shunt before hepaticojejunostomy necessary?
BACKGROUND
Portal hypertension develops in 15-20% of patients with benign bile duct stricture. Hepaticojejunostomy in such patients is associated with considerable morbidity and mortality. Preliminary portosystemic shunting has been suggested to reduce intra-operative bleeding. We present our experience without preliminary shunting in such patients.


METHODS
Fourteen consecutive cases of biliary stricture with portal hypertension over a 13-year period (1989-2001) were retrospectively analysed.


RESULTS
Thirteen patients were operated upon. One patient had a preliminary portosystemic shunt. In another patient, shunt was attempted. One stage hepaticojejunostomy was possible in 11 patients. There were no intra-operative deaths. Nine of the 13 survived and were available for follow-up. One patient had cholangitis. Another had jaundice related both to chronic liver disease and a strictured hepaticojejunostomy. The remaining 7 patients are asymptomatic and anicteric although alkaline phosphatase levels remain elevated in 5 of them.


CONCLUSIONS
Hepaticojejunostomy without preliminary portosystemic shunting is possible in patients with portal hypertension and benign biliary stricture with acceptable morbidity and mortality rates.
Perakath
B
B
Department of General Surgery Unit 1, Christian Medical College and Hospital, Vellore, Tamil Nadu, India. sur1@cmcvellore.ac.in
Sitaram
V
V
Mathew
G
G
Khanduri
P
P
D000293:Adolescent; D000328:Adult; D002763:Cholecystectomy / Q000009:adverse effects* / Q000379:methods; D002779:Cholestasis / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology / Q000601:surgery*; D007583:Jejunum / Q000601:surgery; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010030:Ostomy / Q000379:methods; D011170:Portasystemic Shunt, Surgical / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome