Schweizer et al listed risk factors associated with the need for specialized biliary reconstruction in a patient with a complex benign biliary tract obstruction. Standard surgical techniques for biliary reconstruction may fail in these patients, and combined interventions by surgeons, interventional radiologists and gastroenterologists may be required. The authors are from the University of Berne in Switzerland.
Causes for a complex benign biliary obstruction:
(1) congenital anomalies
(2) post-surgical
(3) traumatic
(4) post-infectious
Parameters:
(1) Bismuth type of biliary stricture
(2) extent of biliary stricture
(3) number of previous operations
(4) hepatic atrophy/hypertrophy complex
(5) portal hypertension
(6) intrahepatic concretions or debris
(7) episodes of cholangitis and jaundice
(8) liver function
(9) biliary fistulae
|
Parameter |
Finding |
Points |
|
Bismuth type of biliary stricture |
Types 1 or 2 |
0 |
|
|
Types 3, 4 or 5 |
1 |
|
extent of biliary stricture |
none or focal |
0 |
|
|
segmental or diffuse |
1 |
|
number of previous operations |
none or 1 |
0 |
|
|
2 or more |
1 |
|
hepatic atrophy/hypertrophy complex |
absent |
0 |
|
|
present |
1 |
|
portal hypertension |
absent |
0 |
|
|
present |
1 |
|
intrahepatic concretions or debris |
absent |
0 |
|
|
present |
1 |
|
episodes of cholangitis and jaundice |
0, 1 or 2 |
0 |
|
|
recurrent |
1 |
|
liver function |
normal |
0 |
|
|
impaired, including diffuse fibrosis and cirrhosis |
1 |
|
biliary fistulae |
none |
0 |
|
|
external and/or internal fistulae present |
1 |
total number of risk factors =
= SUM(number of risk factors present)
Interpretation:
• minimum number of risk factors: 0
• maximum number of risk factors: 9
• The presence of 3 or more risk factors identified patients who usually required specialized repair.
Specialty: Gastroenterology, Surgery, general
ICD-10: ,
