THE USE OF ANTEGRADE ENDOBILIARY INTERVENTIONS IN BENIGN DISEASES OF THE BILIARY TRACT COMPLICATED BY MECHANICAL JAUNDICE

Introduction. One of the most common manifestations of diseases of the biliary tract are strictures or stenoses. They can have malignant, inflammatory and traumatic etiology, as well as be accompanied by mechanical jaundice syndrome. Aim. To study the results of the use of antegrade endobiliary interventions in benign diseases of the biliary tract complicated by mechanical jaundice. Materials and methods. An analysis of surgical treatment of 34 patients with benign diseases of the biliary tract complicated by mechanical jaundice (MJ) in the SI “V.T. Zatsev IGUS NAMSU». Choledocholithiasis was the cause of MF in 21 (61.8 %) cases, stricture of the LV in 6 (17.6 %) and stricture of the biliodigestive anastomosis (BDA) in 7 (20.6 %) patients. BDA strictures developed after the following operations: biliobiliostomy — 1 (14.3 %), hepaticojejunostomy — 3 (42.9 %), choledochoduodenoanastomosis — 2 (28.5 %) and hepaticoduodenostomy — 1 (14.3 %) %). Research results. External percutaneous transhepatic cholangiodrainage was performed in 7 (46.7 %) patients, external-internal percutaneous transhepatic cholangiodrainage was performed in 6 (40 %), percutaneous transhepatic cholecystostomy was performed in 2 (13.4 %) patients. With slightly dilated intrahepatic ducts (<5 mm) cholangiodrainage was established in 3 (20 %) patients. Of these, in 3 (20.0 %) cases, a separate percutaneous transhepatic cholangiodrainage of the right and left lobular ducts of the liver was performed. Performing percutaneous transhepatic cholangiography and percutaneous transhepatic cholangiodrainage allows to determine the level and nature of biliary block in a minimally invasive way, to perform biliary decompression and prevention of complications after an unsuccessful attempt at endoscopic treatment. Conclusions. By using antegrade endobiliary interventions, we were able to reduce the risk of biliary decompression complications compared with patients who had unsuccessful attempts at endoscopic treatment from 15 (78.9 %) to 1 (6.67 %), and to reduce the number of complications after reconstructive rehabilitation. operations from 10 (52.6 %) to 1 (6.67 %) and the mortality rate from 2 (10.5 %) to 1 (6.67 %).

Minimally Invasive Method of Treatment of Biliary Tract Strictures

The article presents a minimally invasive method for treating strictures of a biliodigestive anastomosis, which consists in creating access to the intestinal lumen without entering the abdominal cavity. A guideline in this is the scar on the anterior abdominal wall, which remained after the removal of the circular drainage or Volker's drainage. In this way, in our clinic, 10 patients were operated on after an operation to form a biliodigestive anastomosis on a disconnected RF loop. A clinical case with a follow-up period of more than 10 years is presented. There was no recurrence of strictures, and according to the data of clinical, echographic and biochemical examinations, all of them had a good long-term result.

Surgical management of a patient with biliodigestive anastomosis stricture complicated by multiple intrahepatic lithiasis

A clinical case of surgical management of patient with biliodigestive anastomosis stricture complicated by multiple intrahepatic lithiasis is presented. The patient was 57 years old woman. Anamnesis of the disease: in 2016, biliodigestive anastomosis was performed due to iatrogenic damage of the biliary tract. She was admitted to the hospital with complaints of the right upper abdomen pain, accompanied by chills, jaundice, and fever up to 39°C. The examination revealed a stricture of a previously formed biliodigestive anastomosis complicated by multiple intrahepatic cholelithiasis. Surgical intervention was performed: at the first stage – percutaneous transhepatic cholangiostomy; at the second stage – laparotomy, separation of hepaticojejunoanastomosis, intraoperative cholangioscopy with lithoextraction, resection of a small bowel section with a Brownian anastomosis, post-colon hepaticojejunostomy on a disconnected loop and replaceable transhepatic drains (Smith-Praden-Saypol-Kurian).

PERCUTANEOUS TRANSHEPATIC CHOLANGIOGRAPHY IN THE DIAGNOSTICS OF COMMON BILE DUCT DISEASES COMPLICATED BY OBSTRUCTIVE JAUNDICE*

Aim: Evaluation of the effectiveness of percutaneous transhepatic cholangiography in the diagnostics of bile duct diseases complicated by obstructive jaundice. Material and methods: This article presents the experience of using percutaneous transhepatic cholangiography in 88 patients with benign and malignant common bile duct diseases complicated by obstructive jaundice. Results: Methods of direct contrasting of the biliary tract make it possible to visualize choledocholithiasis with 86.5% accuracy, with 84.1% common bile duct strictures, with 87.8% stricture of biliodigestive anastomosis and with 97.5% accuracy of cholangiocarcinomas. Conclusions: Direct antegrade bile duct enhancement should be used if ERCPG has low explanatory value. PTCG in case of “endoscopically complicated forms” of choledocholithiasis, CBD and BDA strictures and cholangiocarcinomas enhances all bile duct sections and helps assess the level and completeness of biliary blockade. Following PTCG, measures can be taken to achieve biliary decompression regardless of OJ genesis.

Choledocholithiasis as a cause of obstructive jaundice after pancreatoduodenal resection

Obstructive jaundice is one of the main symptoms of diseases of hepatobiopancreatoduodenal region organs and occurs in 12.0-45.2% of cases. The article describes a clinical case of successful treatment of a patient with choledocholithiasis that occurred three years after gastropancreatoduodenal resection performed for pancreatic head cancer. Patients often die before they develop long-term postoperative complications, among which we can distinguish cicatricial strictures of biliodigestive anastomosis, which occur in 0.8% of cases, and the development of obstructive jaundice, which is primarily characteristic of the progression of the underlying disease or relapse. While analyzing the literature, we didnt find any statistically significant data regarding the incidence of gallstone disease (cholelithiasis) as a cause of obstructive jaundice in the patients after pancreatoduodenal resection. Thus, the clinical case presented below is of particular interest.

SURGICAL APPROACH AT IATROGENIC INJURIES OF EXTRAHEPATIC BILIARY TRACTS

Aim: To study the efficiency of reconstructive operations in “recent” iatrogenic injuries of extrahepatic biliary tracts. Methods. The experiment on surgical treatable of 22 patients with iatrogenic “recent” injuries of extrahepatic biliary tracts is submitted. Primary reparative operation has been performed to 1 patient (suturing of hepaticocholedochus injury after Laparoscopic cholecystectomy). Reparative operations throughout Roux-en-Y biliodigestive anastomosis were performed to 19 patients (Roux-en-Y hepaticojejunostomy - 4, Roux-en-Y bihepaticojejunostomy - 13, Roux-en-Y trihepaticojejunostomy - 2). The external drainage of extrahepatic biliary tracts of the 2nd patient has been the final method of surgical treatable. Results.Post-surgery complaints and mortalities. Among all the 22 patients with iatrogenic injuries of extrahepatic biliary tracts the post-surgery complaints of 4 patients have been registered: failure of stitches of Roux-en-Y bihepaticojejunostomy - 1, acute adhesive small bowel obstruction - 1, stenosis of bihepaticojejunostomy - 1, purulence of surgical wound - 1. Post-surgery mortality is 4,5 %. Conclusion.Roux-en-Y biliodigestive surgery is the main conclusive method in reconstructive treatment of iatrogenic injuries of extrahepatic biliary tracts.