after initial surgery is common in patients who undergo bile duct resection for both
benign and malignant diseases.
A recent study
revealed that the cumulative incidence of stricture was 12.5% at 2 years in the study
series, which included 3374 patients who underwent hepaticojejunostomy. Only 18 (4.5%)
patients among them with stricture could undergo revision surgery. Most patients with
benign postoperative biliary stricture are generally managed non-operatively, and
the outcomes after interventional therapies using endoscopic and/or radiologic approaches
are reportedly sufficient nowadays.
The gold standard for the management of benign biliary stricture is currently endoscopy
with balloon dilatation and placement of biliary stents, or interventional radiologic
approach with percutaneous trans-hepatic biliary approach. However, these non-surgical
approaches employing endoscopic and radiologic treatments for benign hepaticojejunostomy
stricture are not always able to provide both short-term and long-term satisfactory
outcomes in every patient with anastomotic strictures. From the perspective of short-term
outcomes, these non-surgical approaches do not successfully relieve biliary stricture
in 10–20% of the patients.
Furthermore, there were also some patients with biliary stricture from hepaticojejunostomy
who could not obtain long-term relief by only using interventional endoscopic and/or
radiologic approaches. These patients with refractory hepaticojejunostomy stricture
must undergo surgical revision of the hepaticojejunostomy stricture, as reported in
However, revision hepaticojejunostomy previously reported in small series met with
inconsistent satisfactory results.
The recurrent stricture is notoriously difficult to manage because of the development
of extensive scar tissue from prior surgeries at the hepatic hilum. Therefore, revision
hepaticojejunostomy is often associated with several technical difficulties, which
need to be overcome for satisfactory surgical outcomes. The complex vascular anatomy
of the hepatic artery and the portal vein and severe adhesions due to previous surgery
might cause injuries to the vessels during revision hepaticojejunostomy. The technical
difficulties and increased surgical morbidities, specifically the high risk of impaired
arterial blood supply to the liver and bile duct, are usually associated with surgical
revision of hepaticojejunostomy strictures. Furthermore, there have been recurrent
episodes of biliary stricture even after surgical revision in long-term follow-up.
Revision hepaticojejunostomies reported in most studies are usually accompanied with
the resection of stricture anastomosis of previous hepaticojejunostomy at the initial
surgery, and re-reconstruction of hepaticojejunostomy using both cut-ends of the previous