Patients with one or more risk factors may have a poor outcome or stricture recurrence after surgical reconstruction of the bile ducts. These patients may require alternative therapy and closer monitoring.


Risk factors - general patient factors:

(1) advanced age

(2) poor general health


Risk factors - stricture:

(1) proximal stricture of the extrahepatic bile ducts (Bismuth Type 3 or Type 4)

(2) intrahepatic strictures

(3) multiple strictures


Risk factors - surgical:

(1) multiple previous attempts at repair

(2) surgeon inexperience

(3) end-to-end biliary anastomosis


Risk factors - liver disease:

(1) portal hypertension

(2) hepatic lobar atrophy

(3) intrahepatic lithiasis

(4) hepatic cirrhosis, fibrosis or other hepatic parenchymal disease


Risk factors - abnormal bile drainage:

(1) intra-abdominal bile collection (implies leakage)

(2) internal or external biliary fistula


Risk factors - infection:

(1) acute cholangitis

(2) intra-hepatic abscess

(3) intra-abdominal abscess


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