In which pa of the common bile duct does biliary stricture develop after laparoscopic cholecystectomy?: (A) Upper, (B) Middle, (C) Lower, (D) All side with equal frequency
Answer is A. Following laparoscopic cholecystectomy, biliary stricture most commonly develop at the upper pa of the common bile duct. Postoperative biliary stricture occur as a result of unexpected ischemic injury or a misplaced surgical clip. Treatment involves stricture dilatation using a balloon dilator or graduated catheter dilator over a guide wire. Grades of site of stricture formation: Grade I: occur more than 2 cm from the confluence of right and left hepatic duct Grade II: involve common hepatic duct, less than 2cm from the confluence Grade III: within 1 cm of confluence Grade IV: involve hepatic confluence Ref: Sabiston Textbook of Surgery, 17th Edition, Page 1623 ; Liver and Biliary Tract Surgery: Embryological Anatomy to 3D-Imaging and transplant innovations By Constantine Ch Karaliotas, Pages 180-81 ; Schiff's Diseases of the Liver By Eugene R. Schiff, 11th Edition, Pages 78-80