Abstract
Terminal common bile duct (choledochus) stenoses are often difficult differentially diagnostic problem. Doubts about optimal treatment plan are connected with it.
Based on our experience, we would like to point present surgical treatment possibilities of terminal common bile duct stenosis and to present their outcomes. We have evaluated findings and outcomes of treatment retrospectively in 153 patients having been operated in Department of Surgery of 2nd Medical Faculty Charles University with a diagnosis of terminal common bile duct stenosis during January 1995 - January 2003.
Post-operative mortality (up to 30 days post after a surgery), post-operation morbidity and obstruction icterus incidence during the further course of disease were chosen as basic evaluation criteria. Results: During a followed period 79 radical resections (partial duodenopancreatectomy) and 74 biliodigestive anastomoses were performed.
Nine patients (5,8 %) died within 30 days after the surgery. Morbidity was 13,7 % and recurrence of obstruction was noted in 3 (2 %) patients operated.
Surgical treatment is indicated in patients with terminal common bile duct stenosis of unclear biological origin, in patients with malignant stenosis in good general condition and longer survival supposed and in majority of patients with benign stenosis or stricture of terminal common bile duct. Main argument for surgical treatment is the possibility of tumorous or fibrotic tissues radical resection in part of patients.
In palliative bypasses because of malignity or benign reason is a surgical treatment favourable due to long-lasting common bile duct drainage efficiency.