INTRAHEPATIC CHOLANGIOJEJUNOSTOMY IN BILIARY STRICTURE FOLLOWING RESECTIONAL LIVER SURGERY

Background. Biliary strictures after resectional liver surgery is a severe complication and remains a challenge. In this study we present our experience with intrahepatic cholangiojejunostomy (IHCJ) as the method of choice for the management of this complication. Methods. Between September 1983 and January 1993, 115 IHCJs were performed. Five of those were carried out to treat biliary stricture following resectional liver surgery. One IHCJ was done in 1986 in Amsterdam and the remaining four between 1991 and 1993 in Athens, Greece. IHCJ involves an anastomosis between an isolated Roux-en-Y jejunal loop and the segmental hepatic ducts of the residual liver. We had two female and three male patients, all presenting with severe, persistent jaundice following liver resectional surgery. The probable cause was a mechanical injury in three patients and an impaired blood supply in the remaining two. Results. After IHCJ, all five patients are alive and well. The first patient, who was operated on in 1986, remains completely symptom-free, with normal liver function tests and a good post-operative quality of life. Similarly, the remaining four patients, who underwent IHCJ from 1991 onward, have normal liver function tests and are symptom-free post-operatively. Conclusions. The present results suggest that IHCJ is a promising surgical approach to the management of biliary stricture following resectional liver surgery.