Narrowing at the biliary enteric anastomosis after Roux-En-Y surgery operation

[willix]

Suspected to have Klatskin Tumor because of the stricture of the bile duct, I was given a surgery operation on Nov. 2005.  But, during the operation, it is diagnosed that it is not tumor and it is Possible Common Bile Duct Stricture As a Result of Previous Surgery (I took gallbladder removed about 15 years ago). During this surgery, the following steps were performed:
1)Laparotomy 2)Extrahepatic Bile Duct Resection 3)Hepaticojejuno-stomy Times Two 4)Roux-En-Y 5)Portal Lymph Node Dissection.
About three months after the operation, I started feeling pressure frequently and then in the middle of March 2006, I got high temperature and serious jaundice. Sent back to the hospital, the doctor said it was caused by the narrowing at the biliary enteric anastomosis. The doctor had a KMP catheter used for access across the stenosis into the small bowel following which the anastomosis was dilated with a 10X40 mm balloon followed by placement of a 14-rench internal-external biliary drain.
Since then, I went to the hospital about every 2 months to take Cholangiogram, biliary dilatation and buliary tube exchange.
It has been almost one year to repeat above procedure. In the last tube exchange happening on Feb.23, 2007, the radiologist said the narrow is still there and he did not see contrast going down to the bowl freely. I am just wondering if the method using the tube can finally get ride of the narrow.  Should I be patient to wait for another several months/years, or I should take re-operation to solve the problem? Thank you in advance.

[Kevin Pho, MD]

This is a difficult question to answer without reviewing your case.  The decision to repeat stenting versus another operation would vary from patient to patient, as well as the severity of the disease.  

If the repeated stenting does not stop the bilirubin from rising, then surgery can be considered.  

Refractory cases such as this one should be evaluated by a major academic medical center for another opinion regarding future options.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
kevinmd_

[willix]

Dear Dr. Kevin,

Thank you very much for your replying!

The relative doctors around me can not reached an agreement. That’s the reason I expect to get some help from you. I am 43 years old and my recent alkakine phosphatase is 138 (30~130), bilirubin total is 48( 0~24) and GGT  is 274 (11~63).

Based on your experience on the biliary system, do you think using drain tube is an effective method to finally get ride of the narrowing at the biliary enteric anastomosis? If the method works finally, on average, how many months/years does it need? Is it possible that keeping the tube could cause some damage to the liver, like cirrhosis, or bile duct problem?

Thank you again.

[Idab]

Unfortunatley this doc aint going to help you.  I think your condition is far too complicated for him to diagnose over the internet.  Keep up with your current panel of doctors.  As there has been no improvement in a year - I would seriously discuss all other options, including surgery with current doctors and get the prognosis (end result/outcome) of whatever procedures they plan on carrying out there and then.  Sounds to me like they 'stuffed up' when they did the initial surgery for tumour growth and all the other cris crossing.  Have faith.