title: [Biliary stent placement for postoperative benign bile duct stenosis: personal experience].
abstract: OBJECTIVE
  To describe the management and outcome after endoscopic treatment of 23 patients with post-operative benign bile duct stricture (BBDS) managed in Authors' Department from 1991 to 2000.
  
  
  BACKGROUND
  The management of the postoperative bile duct strictures remains a challenge for even the most skilled biliary tract surgeon and endoscopist. The 1990s saw a dramatic increase in the incidence of bile duct strictures from the introduction and widespread use of laparoscopic cholecystectomy. The management of these injuries, short-term outcome and follow-up have been reported.
  
  
  METHODS
  Data were collected retrospectively on 23 patients treated in the Service of Diagnostic and Operative Endoscopy of the Operative Unit of General and Thoracic Surgery (Policlinico Paolo Giaccone, Palermo, Italy) with BBDS between 1991 and 2000. All patients underwent ERCP (endoscopic retrograde cholangiopancreatography). Follow-up and pharmacological therapy post-ERCP were conducted by scheduled medical audit.
  
  
  RESULTS
  Of the 23 initial patients, 20 undergoing endoscopic stenting (3 with complete transaction were invited to surgery), 16 had completed treatment with symptoms resolution (mean follow-up of 70 months). One patient died of reason unrelated to biliary tract disease before the completion of treatment. Seven had not completed treatment. Of 16 patient who had completed treatment, 13 were considered to have a successful outcome without the need of follow-up invasive, diagnostic or therapeutic interventional procedures. Overall, a successful outcome, was obtained in 65% of patients, including those requiring a secondary procedure for recurrent strictures.
  
  
  CONCLUSIONS
  Postoperative bile duct strictures remain a considerable surgical challenge. Management with endoscopic cholangiography to delineate the postoperative anatomy and to place biliary stents, to solve the symptoms, is associated with a successful outcome in up of 65% of patients, in well experienced team. Endoscopic treatment should be the initial management of choice for postoperative bile duct stenosis, as a real alternative to surgical reconstruction: because his failure will not compromised the following surgical treatment prior endoscopic treatment does not preclude surgery), whereas endoscopic treatment is impossible one a Roux-en-Y loop has been constructed
authors.affiliation: Unità Operativa di Chirurgia ad Indirizzo Toracico, Dipartimento di Chirurgia Generale d'Urgenza e dei Trapianti d'Organo, Policlinico P. Giaccone, Università degli Studi di Palermo. carmesci@hotmail.com
authors.forename: Carmelo
authors.initials: C
authors.lastname: Sciumè
authors.forename: Girolamo
authors.initials: G
authors.lastname: Geraci
authors.forename: Franco
authors.initials: F
authors.lastname: Pisello
authors.forename: Tiziana
authors.initials: T
authors.lastname: Facella
authors.forename: Francesco
authors.initials: F
authors.lastname: Li Volsi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Modica
mesh_terms: D000328:Adult; D000368:Aged; D001652:Bile Ducts / Q000473:pathology* / Q000601:surgery*; D001662:Biliary Tract Surgical Procedures / Q000379:methods*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects; D003251:Constriction, Pathologic / Q000209:etiology / Q000601:surgery; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome