Résumé
Background: biliary anastomotic strictures (BAS) after liver transplantation cause significant morbidity. Endoscopy is the first-line treatment, while surgical hepaticojejunostomy (HJS) is reserved as a second-line option. This study assessed long-term outcomes for hepatic prognosis and survival after BAS resolution, comparing both management. Methods: liver transplant patients with choledocho-choledochal anastomosis from December 2011 to November 2020, developing BAS, were included. Two groups were defined based on stricture resolution method: endoscopy group (multiple ERCPs) and surgery group (HJS). Patients in the endoscopy group who underwent HJS for recurrence of BAS after its initial resolution remained in the endoscopy group. Primary outcome was "death-censored graft survival" after stricture treatment. Both groups were evaluated for overall survival, stricture recurrence rates, and biliary complications. Results: 141 patients were included, 112 in endoscopy group and 29 in surgery group (22/29 with initial endoscopic treatment failure). In endoscopy group, 13 payents underwent HJS during follow-up due to recurrent BAS. Endoscopic treatment was longer in the surgery group (16.12 months ± 13.93 vs 9.5 months ± 6.49, p=0.009), with higher morbidity (13.79% vs. none requiring ICU admission). Following HJS, the surgery group had significantly higher morbidity (13.8%, vs 0%), including two post-surgical deaths. No difference was observed in graft survival (p=0.585) or overall survival (p=0.317). Stricture recurrence rates reached 24% in the endoscopy group. After HJS, 18% developed non-obstructive cholangitis. Conclusion: endoscopic treatment remains a valuable first-line approach, but surgical intervention does not appear to adversely impact long-term prognosis. Considering surgical option earlier is advisable, as prolonged endoscopic treatment appears to be associated with increased morbidity after hepaticojejunostomy.