title: Percutaneous transhepatic balloon dilation of biliary-enteric anastomotic strictures after surgical repair of iatrogenic bile duct injuries.
abstract: OBJECTIVE
  To evaluate the efficacy of percutaneous balloon dilation of biliary-enteric anastomotic strictures resulting from surgical repair of laparoscopic cholecystectomy-related bile duct injuries.
  
  
  METHODS
  A total of 61 patients were referred to our institution from 1995 to 2010 for treatment of obstruction at the biliary-enteric anastomosis following surgical repair of laparoscopic cholecystectomy-related bile duct injuries. Of these 61 patients, 27 underwent surgical revision upon stricture diagnosis, and 34 patients were managed using balloon dilation. Of these 34 patients, 2 were lost to follow up, leaving 32 patients for analysis. The primary study objective was to determine the clinical success rate of balloon dilation of biliary-enteric anastomotic strictures. Secondary study objectives included determining anastomosis patency, rates of stricture recurrence following treatment, and morbidity.
  
  
  RESULTS
  Balloon dilation of biliary-enteric anastomotic strictures was clinically successful in 21 of 32 patients (66%). Anastomotic stricture recurred in one of 21 patients (5%) after an average of 13.1 years of follow-up. Patients who were unsuccessfully managed with balloon dilation required significantly more invasive procedures (6.8 v. 3.4; p = 0.02) and were left with an indwelling biliary catheter for a significantly longer period of time (8.8 v. 2.0 months; p = 0.02) than patients whose strictures could be resolved by balloon dilation. No significant differences in the number of balloon dilations performed (p = 0.17) or in the maximum balloon diameter used (p = 0.99) were demonstrated for patients with successful or unsuccessful balloon dilation outcomes.
  
  
  CONCLUSIONS
  Percutaneous balloon dilation of anastomotic biliary strictures following surgical repair of laparoscopic cholecystectomy-related injuries may result in lasting patency of the biliary-enteric anastomosis.
authors.affiliation: Department of Radiology, University of California San Francisco, San Francisco, California, United States of America.
authors.forename: Andrew Y
authors.initials: AY
authors.lastname: Lee
authors.forename: John
authors.initials: J
authors.lastname: Gregorius
authors.forename: Robert K
authors.initials: RK
authors.lastname: Kerlan
authors.forename: Roy L
authors.initials: RL
authors.lastname: Gordon
authors.forename: Nicholas
authors.initials: N
authors.lastname: Fidelman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001649:Bile Duct Diseases / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D001652:Bile Ducts / Q000293:injuries* / Q000601:surgery; D002404:Catheterization / Q000379:methods*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D016896:Treatment Outcome; D055815:Young Adult