Trifonov S, Kovalenko Y, Gurmikov B, Varava A, Vodeiko V, Pakhtushkin E, Vishnevsky V, Zharikov Y. Reconstructive surgery and percutaneous balloon dilation for the treatment of benign biliary strictures: A retrospective study. World J Hepatol 2025; 17(5): 104646 [PMID: 40501473 DOI: 10.4254/wjh.v17.i5.104646]
Corresponding Author of This Article
Yury Zharikov, MD, PhD, Associate Professor, Department of Human Anatomy and Histology, FSAEI HE I.M. Sechenov First MSMU of MOH of Russia (Sechenovskiy University), Mokhovaya Street 11s10, Moscow 125009, Russia. dr_zharikov@mail.ru
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Surgery
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Retrospective Study
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May 27, 2025 (publication date) through Mar 3, 2026
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World Journal of Hepatology
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Trifonov S, Kovalenko Y, Gurmikov B, Varava A, Vodeiko V, Pakhtushkin E, Vishnevsky V, Zharikov Y. Reconstructive surgery and percutaneous balloon dilation for the treatment of benign biliary strictures: A retrospective study. World J Hepatol 2025; 17(5): 104646 [PMID: 40501473 DOI: 10.4254/wjh.v17.i5.104646]
World J Hepatol. May 27, 2025; 17(5): 104646 Published online May 27, 2025. doi: 10.4254/wjh.v17.i5.104646
Reconstructive surgery and percutaneous balloon dilation for the treatment of benign biliary strictures: A retrospective study
Sergei Trifonov, Yury Kovalenko, Beslan Gurmikov, Aleksey Varava, Valeria Vodeiko, Evgeniy Pakhtushkin, Vladimir Vishnevsky, Yury Zharikov
Sergei Trifonov, Yury Kovalenko, Beslan Gurmikov, Aleksey Varava, Vladimir Vishnevsky, Department of Surgical Oncology, A.V. Vishnevsky National Medical Research Center of Surgery, Moscow 115093, Russia
Valeria Vodeiko, Evgeniy Pakhtushkin, Yury Zharikov, Department of Human Anatomy and Histology, FSAEI HE I.M. Sechenov First MSMU of MOH of Russia (Sechenovskiy University), Moscow 125009, Russia
Author contributions: Trifonov S, Gurmikov B, and Vishnevsky V were responsible for concept development, supervision, preparation of the first draft of the manuscript, and approval of the final draft; Kovalenko Y was responsible for supervision, data collection, and approval of the final draft; Pakhtushkin E was responsible for data collection, visualization, manuscript preparation and editing, and approval of the final draft; Varava A is responsible for data aquisititon, formal analysis, manuscript writing and editing, approved final draft; Vodeiko V is responsible for visualization, formal analysis, manuscript writing, review and editing, approved final draft; Zharikov Yury is responsible for supervision, conceptualization, manuscript preparation, review and editing, approved final draft.
Institutional review board statement: The study complied with the norms of the Declaration of Helsinki and was fully approved by the Local Ethics Committee of the A.V. Vishnevsky National Medical Research Center of Surgery under protocol No. 08-19 on 05.06.2019.
Informed consent statement: All participants gave informed consent prior to the study.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Data sharing statement: No additional data available.
Corresponding author: Yury Zharikov, MD, PhD, Associate Professor, Department of Human Anatomy and Histology, FSAEI HE I.M. Sechenov First MSMU of MOH of Russia (Sechenovskiy University), Mokhovaya Street 11s10, Moscow 125009, Russia. dr_zharikov@mail.ru
Received: December 31, 2024 Revised: March 25, 2025 Accepted: April 22, 2025 Published online: May 27, 2025 Processing time: 148 Days and 13 Hours
Abstract
BACKGROUND
It is well known that in case of high initial strictures of bile ducts surgical treatment is associated with a high risk of damage to the hepatoduodenal ligament elements, often involved in rough scarring, and with a significant risk of stricture recurrence.
AIM
To compare the long-term outcomes of different surgical treatment options for patients with high-grade benign biliary strictures.
METHODS
From 2012 to 2022, 193 patients were treated at the A.V. Vishnevsky Surgical Center. All of them had different levels of strictures according to Bismuth-Strasberg classification: Type E1-2 in 32 patients, type E3 - 99, type E4 – 62.123 patients underwent open reconstructive interventions, 70 percutaneous endobiliary interventions.
RESULTS
Long-term results were available for 192 (99%) patients with a follow-up of 4.7 ± 1.6 years after reconstructive surgery; 3.0 ± 1.4 years after percutaneous interventions. Excellent and good results (according to Terblanche classification) were achieved in 35% (42/122) of patients after open reconstructive surgery and in 13% (9/70) of patients after percutaneous transhepatic interventions (P-value < 0.05).
CONCLUSION
Technically, the most difficult bile duct strictures for reconstructive and percutaneous transhepatic interventions with a high recurrence rate are Bismuth-Strasberg type E4 and E5. The comparative analysis of long-term results of percutaneous and open procedures showed a statistically significant advantage of percutaneous procedures compared to open reconstructive procedures.
Core Tip: Percutaneous transhepatic biliary drainage (PTBD) are an effective and safe way to treat patients with high benign biliary strictures. The first step is to consider PTBD in cases of high benign biliary strictures. Only when minimally invasive procedures are ineffective should reconstructive procedures be considered.
