Incidence of Post-Operative Stricture Following Hepaticojejunostomy for Benign and Malignant Disease: Stricture Risk After Hepaticojejunostomy

Muhammad Amin; Misbah Ullah; Maryam Munir; Ishfaq Ullah

doi:10.54393/pjhs.v6i6.3110

Authors

Muhammad Amin Department of General Surgery, Northwest Hospital, Peshawar, Pakistan
Misbah Ullah Department of Surgery, District Headquarters Hospital, Malakand, Pakistan
Maryam Munir Department of Surgery, District Headquarters Hospital, Landikotal, Pakistan
Ishfaq Ullah Department of Surgery, Naseer Teaching Hospital, Peshawar, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v6i6.3110

Keywords:

Hepaticojejunostomy, Biliary Structure, Benign, Malignant Obstruction, Biliary Surgery Outcomes

Abstract

Hepaticojejunostomy remains essential for biliary obstruction management, yet postoperative strictures significantly impact outcomes. Current incidence estimates (4-19%) vary widely due to methodological differences, and recent evidence questions the validity of the commonly referenced 12.5% benchmark used for study design. Objective: To: 1) determine contemporary stricture incidence using standardized criteria, 2) compare benign versus malignant cases, and 3) evaluate 3-month follow-up adequacy. Methods: A prospective cohort study was conducted involving 52 consecutive patients who underwent hepaticojejunostomy, with a mean age of 53.8 years (95% CI: 50.5–57.1). Strictures required both clinical (ICD-9 coding plus symptoms/biochemical evidence) and radiographic confirmation (CT/MR cholangiography). Statistical analyses included exact binomial CIs and chi-square tests (significance at p<0.05). Results: The overall stricture incidence was 19.2% (10/52, 95% CI: 9.6-32.5%). Benign cases showed significantly higher stricture rates (33.3% [8/24], 95% CI: 15.6-55.3%) versus malignant cases (7.1% [2/28], 95% CI: 0.9-23.5%; p=0.017). Conclusions: This study confirmed significantly higher stricture risk in benign disease and suggests current surveillance protocols may require pathology-specific modifications. The statistically significant association (p=0.017) between benign pathology and stricture formation underscores the need for risk-adapted management. Future research should prioritize multicenter cohorts with extended follow-up to validate these findings and refine surveillance guidelines.

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