Operative treatment of benign biliary strictures, particularly those caused by iatrogenic injuries, is burdened by a relatively high risk of recurrent strictures. We have analyzed late results of Roux-en-Y hepaticojejunostomies, the most common surgical procedure for benign biliary strictures. The results of 74 hepaticojejunostomies performed in 62 patients in the years 1965-1995 are presented in this work. Fifty-five patients (67 operations) were subjected to long-term follow-up. The mean observation period was 12.5 years (1-31 years). Since 1976 up to now, the patients have been under careful, periodic assessments, with emphasis on the first 5 postoperative years. The main aim of these systematic examinations was to diagnose early a possible operative failure and to make a quick decision for reoperation. We have found that duration of cholangitis was on average 2 times shorter before reoperation than in the case of primary hepaticojejunostomy. None of 12 reoperations resulted in death. Effectiveness of particular hepaticojejunostomies, as judged by cumulative patency rate, was 75% (83% for I and II Bismuth type, and 60.5% for III and IV Bismuth type). The distant cumulative patency rate increased to 92%, assuming the second successful reconstruction as continuation of effective treatment. All hepaticojejunostomies according to Hepp for hilar stricture were successful, although only in 5 cases among 15 patients, follow-up was longer than 10 years. Our long-term results indicate that careful, periodic postoperative follow-up of patients after hepaticojejunostomy for benign biliary stricture, especially of iatrogenic origin, has a positive influence on final outcome of surgical treatment.
