Objective To investigate the treatment and prevention key points of hilar bile duct stricture after hepatectomy.

Methods The retrospective and descriptive study was conducted. The clinical data of 7 patients who developed hilar bile duct stricture after hepatectomy at Cancer Hospital of Chinese Academy of Medical Sciences and Peking Union Medical College from January 2015 to December 2022 were collected. There were 5 males and 2 females, aged 46(range, 36-58) years. Observation indicators: (1) patient′s hepatectomy conditions and occurrence of hilar bile duct stricture after hepatectomy; (2) patient′s treatment and prognosis; (3) introduction of special case. Measurement data with skewed distribution were expressed as M(range). Count data were expressed as absolute numbers.

Results (1) Patient′s hepatectomy conditions and occurrence of hilar bile duct stricture after hepatectomy: of the 7 patients, 5 patients had hepatocellular carcinoma (4 cases with portal vein tumor thrombus), 1 case had cholangiocellular carcinoma, and 1 case had hepatic hemangioma; 1 patient underwent laparoscopic surgery and 6 patients underwent open surgery, including 3 cases undergoing right hemihepatectomies, 1 case undergoing left hemihepatectomy+caudate lobectomy, 1 case undergoing extended left hemihepatectomy, 1 case undergoing middle liver (segment 4, 5, 8) resection, and 1 case undergoing right three‑segment hepatectomy. For intraoperative hepatic hilum anatomy of the 7 patients, 3 cases underwent extrahepatic dissection and 4 cases underwent intrahepatic dissection. For biliary transection of the 7 patients, 5 cases with a cutting and stapling device, 1 case with a ligation clip, and 1 case with suturing. Analysis of post⁃operative hilar bile duct stricture of the 7 patients, 5 cases developed postoperative hilar bile duct stricture due to excessive compression of the bile duct wall by the cutting and stapling device during the operation, 1 case developed postoperative hilar bile duct stricture due to thermal injury to the bile duct wall caused by an energy device during the operation, resulting in local ischemia and fibrosis, and 1 case developed postoperative hilar bile duct stricture due to scar formation in the bile duct caused by preoperative radiotherapy. For the site of biliary stricture, all 7 patients at the confluence of left and right hepatic pedicles, and 1 patient with hepatic hemangioma developing re-stricture at the biliary‑enteric anastomosis after secondary surgery. All 7 patients developed jaundice, with two of them combined with fever and 4 of them developed early‑onset biliary leakage. The symptoms occurred between the 5th and 720th postoperative day. (2) Patient′s treatment and prognosis: of the 7 patients, 4 patients initially underwent percutaneous transhepatic biliary drainage, with 1 case undergoing liver transplantation 1 year after the procedure, 1 case undergoing choledochojejunostomy 180 days after the procedure, and 2 cases undergoing percutaneous transhepatic combined biliary drainage again after 30 days with drainage tubes replaced regularly. For the other 3 patients, 1 case opted for percutaneous transnasal biliary drainage and had the drainage tube removed after 60 days, 1 case underwent endoscopic retrograde cholangiopancreatography for the placement of a biliary plastic stent and had the stent removed after 180 days, and 1 case underwent right liver (segment 6, 7) resection combined with left liver (segment 2, 3) biliary junction jejunostomy at 150 days after the procedure. Of the 7 patients, 1 case died due to recurrence of liver cancer after liver transplantation, and 6 cases recovered well, including 2 cases currently living with a tube. (3) Introduction of special case: a 58 years male patient, who underwent middle liver (segment 4, 5, 8) resection due to hepatic hemangioma. During the operation, the hemangioma extensively compressed the hepatic portal plate, causing diffuse bleeding from the portal plate after tumor removal. During the hemostasis using a bipolar radiofrequency hemostasis system, the peribiliary blood plexus was damaged, leading to ischemic fibrous scar formation in the bile duct. At 150 days after surgery, the patient developed extensive biliary stricture in the hepatic portal area, accompanied by delayed biliary injury‑related complications such as jaundice and fever. The patient underwent right liver (segment 6, 7) resection combined with left liver (segment 2, 3) biliary junction jejunostomy to repair the biliary stricture. Two years later, the patient underwent percutaneous transhepatic biliary drainage due to biliary-enteric anastomotic stenosis. After regular replacement of the drainage tube for two years, the patient recovered.

Conclusion Treatment for postoperative hilar bile duct stricture after hepatectomy requires a personalized approach based on the specific condition of the patient, which can lead to a favorable prognosis, and the prevention key points includ preoperative precise imaging examination and assess-ment, intraoperative real-time imaging examination guidance, and meticulous surgical operation.