The treatment of iatrogenic injuries of CBD: Surgery vs endoprostheses

Analysis of the long-term results of 83 Roux-en-Y bilio-enteric anastomosis and 25 endoscopic stentings for iatrogenic biliary strictures, has allowed, in spite of drawbacks of a retrospective study, the identification of good indications for treatment. The good long-term results of surgical treatment (84.3%) after a mean follow-up of 8.5 years, have a favorable relationship with an intrahepatic preexisting dilatation of the biliary tree in the absence of chronic rough inflammation of the biliary wall. Otherwise, endoscopic stenting can be a good indication both as definitive treatment and complementary to surgery. On the contrary, the Hutson-Russell loop cutaneous choledochojejunostomy can represent a viable access to intrahepatic biliary tree for endoscopic instrumentation in case of recurrent anastomotic stricture. The long-term results are roughly similar after endoscopic (mean follow-up 23.6 months) and surgical treatment. The cases with unsatisfactory evolution after endoscopic management are the long strictures with late treatment with long-standing biliary infections. Nevertheless follow-ups of endoscopic series are too short to say that long-term results are really definitive. Short and incomplete strictures with bilio-cutaneous fistula have to be thought a good indication to endoscopic treatment. In our opinion self-expanding metallic stents have not to be used in benign strictures.