PORTAL HYPERTENSION AND SECONDARY BILIARY CIRRHOSIS IN POST CHOLECYSTECTOMY BENIGN BILIARY STRICTURES: CAUSE, MANAGEMENT & LONG-TERM OUTCOMES. saurabh_galodha@yahoo.com

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PORTAL HYPERTENSION AND SECONDARY BILIARY CIRRHOSIS IN POST CHOLECYSTECTOMY BENIGN BILIARY STRICTURES: CAUSE, MANAGEMENT & LONG-TERM OUTCOMES.

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India

Oral only

In patients of post cholecystectomy benign biliary strictures (BBS), Portal hypertension (PHT) and secondary biliary cirrhosis (SBC) can lead to increased morbidity and mortality. We analysed factors responsible, peri-operative management and long-term outcomes.

Prospective database of BBS (15 year) was analyzed. Preoperative, intra-operative and peri-operative parameters in patients with or without PHT were compared. McDonald grading used for long-term outcomes

Study included 613 patients of BBS. 19 patients had PHT associated more with higher grade of BBS [ III (n=12,63%) p < 0.01]. Median time to repair was more than four times longer (826 days vs. 210 days, p< 0.01) than those without PHT. Failed previous repair seen in 3 patients of PHT. RYHJ with a liver biopsy was performed in all patients. Hepatic resection (HR) or porto-systemic shunting was not required. Significantly increased mean operating time (4.6 ± 2.8 vs. 3.5 ± 2 hours, p= 0.65) and median blood loss (400 ml vs. 200 ml) was seen in patients with PHT without significant increase in morbidity. Cirrhosis was found in histopathology in 14 patients (72%). Median follow up time was 54 months with long term success rate for RYHJ as 89% and revision RYHJ was required in only 1 patient.

Factors associated with SBC and PHT in patients of BBS were delayed repair, higher grade and failed primary repair. With meticulous approach RYHJ is possible in these patients with excellent long-term results.