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What is The initial investigation of choice for a post cholecystectomy biliary stricture is: and explain in detail?
Ans. is ' d' i.e. ie Magnetic resonance cholangiography The initial investigation of choice for a post cholecystectomy stricture would be an MRCP. It is a non-invasive modality and provides high resolution images of the entire biliary tree. "PTC is the imaging method of choice for most postoperative biliary strictures, but expeise with this is not available at all centers. ERCP may be easier to obtain in a patient with a biliary stricture and cholangitis who requires urgent cholangiography and biliary decompression. However, ERCP is only useful in patients with bile duct continuity."- An ultrasound or a CT can also be used as initial study but an MRCP would be better, as it would provide better anatomic information about the location and the degree of stricture. Management of biliary strictures Schwaz 9/e p11.58 writes- "Percutaneous or endoscopic dilatation and/or stent placement give good results in more than one half of patients. Surgery with Roux-en-Y choledochojejunostomy or hepaticojejunostomy is the standard of care with good or excellent results in 80 to90% of patients."