Sclerosing cholangitis: Biliary reconstruction with Silastic transhepatic stents

Because of multiple areas of stricturing and small fibrotic ducts, sclerosing cholangitis has generally not been amenable to direct reconstructive procedures. In reviewing the cholangiograms of 29 patients with sclerosing cholangitis, it became apparent that despite diffuse disease, the hepatic duct bifurcation was often (22 patients) the most severely narrowed area. Because of this finding it was decided to manage patients who have sclerosing cholangitis, persistent jaundice, and hepatic duct bifurcation narrowing with a direct surgical approach. In 11 patients the extrahepatic biliary tree including the bifurcation was resected and the right and left hepatic ducts were dilated. Bilateral 6 mm silicone rubber (Silastic) transhepatic biliary stents were inserted and bilateral hepaticojejunostomy was performed. Eight patients were men, three were women, and the mean age was 41.9 years. At the time of surgery the mean serum bilirubin concentration was 15.3 mg/dl (range 1 to 50 mg/dl). The disease had been present clinically for a mean duration of 3.6 years. There was one hospital death. Nine of the ten remaining patients have responded with a decrease in serum bilirubin concentration to a mean of 2.9 mg/dl. These nine patients have returned to normal activity. The tenth patient has done poorly and awaits liver transplantation. Follow-up ranges from 4 to 36 months (mean 18 months). The stents have been left in position permanently.