title: Surgical revision of hepaticojejunostomy strictures after pancreatectomy.
abstract: BACKGROUND
  After pancreatic surgery hepaticojejunostomy (HJ) stricture is a rare condition. Usually, management is conservative, while operative revision ("redo") is only rarely performed.
  
  
  METHODS
  This was an observational cohort design that analyzed the outcome of patients who had a surgical revision of HJ strictures after pancreatic surgery at a specialized pancreatic center.
  
  
  RESULTS
  During a period of 7 years from January 2004 until December 2010, 887 patients underwent pancreaticoduodenectomy (PD) or HJ. Among this patient population, 3 % (23/887) underwent a redo of the HJ secondary to stricture formation. Major symptoms of HJ strictures were recurrent cholangitis in 91 % (21/23) and jaundice in 39 % (9/23). The median time from the index operation until redo of the HJ was 16 ± 27 months. The median survival of patients with malignancy after redo of the HJ was 45 ± 67 months. Major surgical morbidity was 9 % (2/23), and mortality was 0 % (0/23). In 78 % (18/23), there were no further episodes of cholangitis after a median follow of 49 ± 73 months, while none of the patients with redo of the HJ developed a restenosis of the HJ.
  
  
  CONCLUSIONS
  Surgical revision (redo) of HJ strictures can be safely performed by an experienced pancreatic surgeon with a low morbidity without mortality with good long-term results.
authors.affiliation: Department of Surgery, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany.
authors.forename: Christopher
authors.initials: C
authors.lastname: Prawdzik
authors.forename: Orlin
authors.initials: O
authors.lastname: Belyaev
authors.forename: Ansgar M
authors.initials: AM
authors.lastname: Chromik
authors.forename: Waldemar
authors.initials: W
authors.lastname: Uhl
authors.forename: Torsten
authors.initials: T
authors.lastname: Herzog
mesh_terms: D000328:Adult; D000368:Aged; D001652:Bile Ducts / Q000473:pathology; D002761:Cholangitis / Q000209:etiology; D003251:Constriction, Pathologic / Q000601:surgery; D005260:Female; D006801:Humans; D007582:Jejunostomy; D008099:Liver / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy; D010182:Pancreatic Diseases / Q000601:surgery; D012008:Recurrence