The following statement(s) regarding the elective repair of a bile duct stricture is/are true:

c.A Roux-en-Y hepaticojejunostomy provides the best route for restoring biliary-enteric continuity

d.Preoperatively-placed biliary catheters facilitate dissection and identification of the stricture and are useful in placement of transanastomotic stents when employed

Several principles are associated with successful repair of a biliary stricture. Although many surgeons favor the use of transanastomotic stents, a number of series have reported successful results without the use of such stents. The length of stenting depends upon the location of the stricture. If the injury involves the common bile duct or common hepatic duct at least 2 cm distal to the hepatic duct bifurcation, and adequate proximal bile duct mucosa can be defined, the use of long-term biliary stents is not necessary. In these situations transanastomotic stenting for 4–6 weeks postoperatively is adequate. When adequate proximal bile duct is not available for a good mucosa-to-mucosa anastomosis, long-term stenting of the biliary-enteric anastomosis with silastic transanastomotic stents for at least a year is recommended. For established strictures, simple excision and end-to-end anastomosis or repair of the damaged duct can rarely be accomplished because of the invariable loss of duct length as a result of fibrosis associated with injury. Thus in almost all cases, hepaticojejunostomy constructed to a Roux-en-Y limb of jejunum is the preferred procedure. The use of preoperatively-placed transhepatic biliary catheters can aid in the dissection and identification of the biliary tree especially in patients with prior attempts at repair where scarring and fibrosis may be significant. In addition, the biliary catheters can assist in the placement of long-term transanastomotic stents.