Management of HILAR malignant biliary strictures.

OBJECTIVE To determine the etiology of Hilar malignant biliary strictures and the efficacy of hepaticojejunostomy in it's management with or without segmental liver resection. PATIENTS AND METHODS A retrospective study of 33 patients was carried out at Civil Hospital & Lyari General Hospital Karachi. They presented with signs and symptoms of mechanical cholestasis. Study was conducted to find the etiology, level of obstruction and the extent of the disease together with approaches to either cure the disease or to relieve the symptoms. Curative resection was attempted where possible in all 33 patients but decision of curative resection or palliative bypass with or without liver resection was made per operatively after accessing the level of obstruction and extent of local, parenchymal or vascular infiltration. RESULT Of the 33 patients studied, 72.73% (n = 24) had cholangiocarcinoma and 27.27% (n = 9) had gall bladder Ca with local bile duct extension. Four different sites of biliary tree (i) common hepatic duct [CHD], (ii) confluence of common hepatic duct [CCHD], (iii) right and left hepatic duct [R&LHD] separately, and (iv) left hepatic duct [LHD] were anastamosed with jejunum. Normal liver functions with complete relieve from symptoms was achieved where CHD or CCHD was anastamosed whereas only a significant decrease was observed when R&LHD and only LHD were anastamosed with jejunum. CONCLUSION Surgical resection of the tumor together with biliary decompression using different approaches of hepaticojejunostomy is an effective way of managing malignant Hilar bile duct obstruction as well as significantly decreasing the severity of symptoms in irresectable tumours.