**8.2.1.1 Duration of follow-up**

IBDI remain a serious clinical problem and a challenge for even the most experienced surgical centers of reference. According to literature, the effectiveness of surgical treatment of IBDI is 70-90%. The recurrent strictures after biliary reconstruction occur in 10-30% of cases. About 80% of postoperative recurrence of biliary strictures are observed during the first five years following reconstruction. Two-thirds (65%) of recurrent biliary strictures develop within 2-3 years after the reconstruction, 80% within 5 years, and 90% within 7 years. Recurrent strictures 10 years after the surgical procedure are also described in the literature. Therefore, the objective assessment of long-term results of surgical treatment plays an important role in the observation period (follow-up) (FU). According to most authors, patients following biliary reconstruction should be observed at least 3 years; according to some authors even 5 to 10 years. Satisfactory length of follow-up, which is necessary in order to assess the long-term results of the repair procedure, is 2 to 5 years. Some authors recommend 10 or 20 years of observation. The criteria of success of surgery include: the absence of clinical symptoms such as biliary jaundice or cholangitis and absence of recurrent stenosis after surgery requiring endoscopic or surgical correction.

The early proper biliary reconstruction is very important, because duration of biliary obstruction is the most important risk factor of biliary cirrhosis. According to literature, prolonged time from injury to repair and portal hypertension are important parameters correlating with secondary biliary cirrhosis. So, early biliary repair can prevent liver fibrosis. According to the literature, biliary cirrhosis occurs in two thirds of patients without effective biliary repair. Portal hypertension is noted in 15-25% of patients with biliary cirrhosis due to IBDI. Reoperations within inflammation, fibrosis and a higher risk of intra-operative bleeding due to portal hypertension with collateral circulation and intraperitoneal adhesions are very difficult and associated with increased mortality rate. Therefore, early and proper biliary reconstruction increases survival rate and decreases morbidity and mortality rates in patients with IBDI.

#### **8.2.1.2 Follow-up classifications**

Different classifications are used for an objective assessment of the effectiveness of biliary repair. The Terblanche scale taking into account clinical parameters is the most frequently used classification [50, 72]. Other less frequently used classifications are the following: the McDonald, Brummelkamp Lygidakis, Cardenas and Munoz, and Nielubowicz scales.


Table 8. Terblanche classification.


Table 9. McDonald classification.

488 New Advances in the Basic and Clinical Gastroenterology

IBDI remain a serious clinical problem and a challenge for even the most experienced surgical centers of reference. According to literature, the effectiveness of surgical treatment of IBDI is 70-90%. The recurrent strictures after biliary reconstruction occur in 10-30% of cases. About 80% of postoperative recurrence of biliary strictures are observed during the first five years following reconstruction. Two-thirds (65%) of recurrent biliary strictures develop within 2-3 years after the reconstruction, 80% within 5 years, and 90% within 7 years. Recurrent strictures 10 years after the surgical procedure are also described in the literature. Therefore, the objective assessment of long-term results of surgical treatment plays an important role in the observation period (follow-up) (FU). According to most authors, patients following biliary reconstruction should be observed at least 3 years; according to some authors even 5 to 10 years. Satisfactory length of follow-up, which is necessary in order to assess the long-term results of the repair procedure, is 2 to 5 years. Some authors recommend 10 or 20 years of observation. The criteria of success of surgery include: the absence of clinical symptoms such as biliary jaundice or cholangitis and absence

of recurrent stenosis after surgery requiring endoscopic or surgical correction.

The early proper biliary reconstruction is very important, because duration of biliary obstruction is the most important risk factor of biliary cirrhosis. According to literature, prolonged time from injury to repair and portal hypertension are important parameters correlating with secondary biliary cirrhosis. So, early biliary repair can prevent liver fibrosis. According to the literature, biliary cirrhosis occurs in two thirds of patients without effective biliary repair. Portal hypertension is noted in 15-25% of patients with biliary cirrhosis due to IBDI. Reoperations within inflammation, fibrosis and a higher risk of intra-operative bleeding due to portal hypertension with collateral circulation and intraperitoneal adhesions are very difficult and associated with increased mortality rate. Therefore, early and proper biliary reconstruction increases survival rate and decreases morbidity and mortality rates in

Different classifications are used for an objective assessment of the effectiveness of biliary repair. The Terblanche scale taking into account clinical parameters is the most frequently used classification [50, 72]. Other less frequently used classifications are the following: the McDonald, Brummelkamp Lygidakis, Cardenas and Munoz, and Nielubowicz scales.

**III Fair result.** Clearly related symptoms requiring medical therapy and/or deteriorating

**I Excellent result.** No biliary symptoms with normal liver function.

**IV Poor result.** Recurrent stricture requiring correction or related death.

**II Good result.** Transitory symptoms, currently no symptoms and normal liver

**8.2 Long-term results and quality of life** 

**8.2.1.1 Duration of follow-up** 

patients with IBDI.

function.

liver function.

Table 8. Terblanche classification.

**8.2.1.2 Follow-up classifications** 

**8.2.1 Follow-up after surgical reconstructions** 


Table 10. Lygidakis i Brummelkamp classification.


Table 11. Muňoz-Cardenas classification.


Table 12. Nielubowicz classification.
