Surgical approaches to benign and malignant biliary strictures
Adenoma, Bile Duct
Bile Duct Diseases
Biliary Tract Neoplasms
The continuing incidence of iatrogenic bile duct injury during biliary surgery and the more frequent preoperative recognition of primary bile duct cancers have resulted in an increasing number of patients with 'high' biliary strictures being referred to specialist surgical units. This contribution describes the management of these lesions. The anatomy of bile duct surgery and the pathophysiologic disturbances that may occur with biliary obstruction are reviewed. The etiology, investigation, and treatment of benign bile duct strictures are then discussed, with an emphasis on postcholcystectomy injuries. Finally, the management and surgical treatment of primary malignancies of the bile duct, in particular hilar cholangiocarcinoma, are described.