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.
Department of General Surgery Unit 1, Christian Medical College and Hospital, Vellore, Tamil Nadu, India. sur1@cmcvellore.ac.in
B
B
Perakath
V
V
Sitaram
G
G
Mathew
P
P
Khanduri
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