الفهرس 
Introduction
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Abstract
Benign stricture of the extrahepatic bile duct occurs due to such diverse etiologies as bile duct trauma from surgery, pancreatitis or sclerosing cholongitis. Aim of the study: This retrospective study aims to evaluate the incidence, epidemology and different modalities in management of benign biliary stricture; endscopic; surgical and others. Patients and methods: This retrospective nonrandomized study was done in GastroEnterology Center (GEC), Mansoura University between Feb 1991 and Feb 2001. One hundred and three patients (103) of benign biliary stricture were subjected to treatment. Those patients were classified according to the cause of the stricture into two main groups. group (I) include patients with postoperative benign stricture after cholecystectomy, this group include 90 patients (20 males and 70 females). This group was divided into two groups according to the line of treatment a) 73 patients underwent surgical intervention (Bilioenteric bypass) and b) 17 patients underwent endoscopic management with multiple sets of dilatation. group (II) include patients with benign biliary stricture of chronic pancreatitis. This group includes 13 patients (8 males and 5 females). Patients of this group underwent surgical intervention; whipple?s operation in (8 patients) and biliary bypass (Hepaticojejunostomy RouxenY) in (3 patients). All these patients were subjected to clinical assessment; laboratory investigation; ultrasonographic examination; evaluation of the biliary tree by different types of cholangiogram and cardiopulmonary assessment and fitness for anesthesia. Results: In group (I): Biliary leakage was the major postoperative complication, it occurred in (12.3%) patients and it was stopped on conservative treatment. Internal haemorrhage occurred in (4.1%) patients and reexplored and bleeding was controlled. Three (4.1%) patients died postoperative (2 patients from heart failure and one patient from hepatorenal failure). Otherwise patients treated with endoscopic dilatation 2 (11.7%) patients developed mild pancreatitis that was treated conservatively and no procedure related mortality occurred. Long term follow up: Recurrent stricture occurred in 2.7%) patients in surgical group, white it occurred in (17.6%) patients in endoscopic group. Seven (9.5%) patients died from hepatorenal failure in surgical group while it was (5.8%) patient in endoscopic group. In group (II): As regard mortality, internal haemorrhage occurred in (8.3%) patient, pancreatic leak in (8.3%) patient, wound infection in (16.6%) patients and lastly no mortality was reported. Long term follow up: There was persistent epigastric pain in one (7.7%) patient and developing of DM in one (7.7%) patient and they were treated medically. Conclusion: In benign postoperative biliary strictures, endoscopic stenting with repeated dilatation is an alternative to surgery although it needs longtime, repeated sets and more cost. It has no serious complication, better in higher stricture, cirrhotics and high risk patients. So endoscopic dilatation is effective but within certain limits and surgical reconstruction has the priority when there is complete ligated CBD with enough biliary dilatation with a good stump, uncooperative patient and absence of biliary peritonitis. In benign stricture due to chronic pancreatitis surgery has a clear role in the management of patient with medically intractable pain or complication resulting from chronic pancreatitis. Surgery results in an increased quality of life for most patients with a reduction in pain and analgesic use, fewer hospital admissions, weight gain and an increase in regular employment.