Management of patients of postcholecystectomy benign biliary stricture complicated by portal hypertension

BackgroundPortal hypertension (PHT) is seen in 15% to 20% of patients with postcholecystectomy benign biliary stricture (BBS). Preliminary portosystemic shunt (PSS) has been recommended to reduce the morbidity and mortality associated with direct stricture repair. Single-center experience of primary repair without preceding PSS in patients of BBS with PHT and a patent portal vein is presented.MethodsA retrospective study of 13 patients with postcholecystectomy BBS with PHT managed between January 1, 2000 and March 31, 2006.ResultsRoux-en-Y hepaticojejunostomy was performed in 11 patients. There was no major morbidity or mortality with minor complications seen in 3 patients. The median duration of surgery was 3.5 hours with a median blood loss of 300 mL. All patients were asymptomatic at a median follow-up of 17 months.ConclusionHepaticojejunostomy can be performed safely without prior portal decompression in patients with postcholecystectomy BBS complicated by PHT but with a patent portal vein.