title: Self-expanding metallic stents in benign postoperative biliary strictures: a difficult surgical obstacle?
abstract: OBJECTIVE
  To report the hazards of surgical management in patients suffering from benign postoperative biliary strictures (BBS) previously treated with self-expanding metallic stents (SEMS).
  
  
  METHODS
  Five patients with BBS were treated by SEMS (Wallstent in 3 patients and Gianturco stent in 2) through an endoscopic (2 patients) or a percutaneous transhepatic route (3 patients). Metallic stent obstruction due to intraprosthetic epithelial hyperplasia was observed in all patients, being responsible for severe cholangitis and intrahepatic stones in 3 and 2 patients respectively.
  
  
  RESULTS
  One patient remains free of symptoms but presented with right posterior liver atrophy. Difficult biliary repair was encountered in 3 patients, requiring excision and reconstruction of the main biliary convergence for severely damaged biliary wall and epithelium by metallic stents. One patient with a SEMS extended upward the right secondary biliary divisions required a right hemihepatectomy.
  
  
  CONCLUSIONS
  The surgical management of benign biliary strictures is severely complicated by the presence of metallic stents. Thus, SEMS should not be employed for treating BBS in healthy patients with a low operative risk.
authors.affiliation: Division of Hepato-Biliary and Pancreatic Surgery, Department of Abdominal Surgery and Transplantation Saint-Luc University Hospital, Brussels, Belgium.
authors.forename: Laurent
authors.initials: L
authors.lastname: Stainier
authors.forename: Catherine
authors.initials: C
authors.lastname: Hubert
authors.forename: Mathieu
authors.initials: M
authors.lastname: Jouret
authors.forename: Pierre
authors.initials: P
authors.lastname: Deprez
authors.forename: Pierre
authors.initials: P
authors.lastname: Goffette
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Gigot
mesh_terms: D000328:Adult; D002758:Cholangiography; D002779:Cholestasis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008670:Metals / Q000009:adverse effects; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D015607:Stents / Q000009:adverse effects*; D016896:Treatment Outcome
chemical_list: D008670:Metals