Liver resection for postcholecystectomy complex benign biliary stricture: A step beyond Roux-en-Y hepaticojejunostomy

Background - Roux-en-Y Hepaticojejunostomy (RYHJ), the standard of care for the definitive treatment of a benign biliary stricture (BBS), may not suffice in patients of BBS with non-reconstructable ducts, atrophy Hypertrophy complex, associated vascular injury, chronic cholangiolytic abscesses or suspicion of malignancy. This study aims to analyze and report the experience of a tertiary care Surgical Gastroenterology center in North India on this subset of BBS where Hepatectomy has been offered as an option. Patients and Method - A retrospective analysis of a prospective database of patients with BBS requiring Hepatectomy from January 1989 to December 2022. Results - 962 patients were treated for BBS during the period – Eighteen (1.87%) of them required Hepatectomy. All patients had high strictures (16 type IV and 2 Type V) with extensive scarring leading to non-reconstructable ducts in 9 (50%), atrophy Hypertrophy complex in 9 (50.0%), Hepatolithiasis in 6 (33.3%), chronic cholangiolytic abscesses in 4 (22.2%), and cirrhosis with portal hypertension in one (5.5%). Associated vascular injuries were present in 8 (44.4%). Mean operating time and blood loss were 10.2hours and 889ml, respectively. Clavien-Dindo Grade ≥ 3 morbidity was seen in 38.9% including two post-operative mortalities (11.1%). At a mean follow-up of 62.8 months, good outcome was seen in 87.5%. Conclusion - In patients with high strictures associated with complications like Non-reconstructable ducts, Atrophy-hypertrophy, vascular injury and/or cholangiolytic abscesses, Hepatectomy may be an optimal therapeutic option providing good long term results with acceptable morbidity and mortality.