Prospective follow-up of patients with bile duct strictures secondary to laparoscopic cholecystectomy, treated endoscopically with multiple stents.

BACKGROUND/AIMS: The frequency of iatrogenic postoperative benign strictures has substantially increased in recent years and this is thought to be because of the widespread use of laparoscopic cholecystectomy. Our study was performed prospectively with the goal to investigate the short-term and long-term outcome for endoscopic treatment with insertion of multiple stents in patients with postoperative benign common bile duct stricture after laparoscopic cholecystectomy.

METHODOLOGY: Overall 43 consecutive patients with history of laparoscopic cholecystectomy were enrolled and followed prospectively between December 1998 and December 2003. In all patients a maximum possible number of stents, in relation to the tightness of the stricture and diameter of the bile duct for a period of one year was inserted endoscopically. Patients entered in the follow-up phase after first ERCP procedure with insertion of a biliary plastic stent and continued to be followed after extraction of all stents.

RESULTS: Successful endoscopic dilatation of benign biliary stricture after laparoscopic cholecystectomy with placement of multiple biliary plastic stents was achieved in all 43 patients (100%), with a mean follow-up of 16.0+/-11.1 months (range 1 to 42 months) after stent removal. The mean number of multiple plastic stents inserted in one patients with the goal to achieve maximum stricture dilation was 3.4+/-0.6 (range 3 to 5). No recurrence of biliary stricture during or at the end of follow-up was noticed in any patients (100% success rate).

CONCLUSIONS: Endoscopic insertion of maximum number of stents in relation to the tightness of the stricture and diameter of the bile duct is highly effective and may improve long-term results for patients with biliary strictures secondary to laparoscopic cholecystectomy.