Significance of lymphodraining operations in complex treatment of non-tumor obstructive jaundice

Abstract

The results of treatment of 118 patients with obstructive jaundice of non-tumor etiology have been analyzed. All patients were divided into control and main groups according to the volume of preoperative preparation and stages of surgical treatment. The control group consisted of 30 patients who were operated after a short-term standard preparation including cholecystectomy and biliary decompression. The main group consisted of 88 patients who underwent two- or three-stage surgical interventions on the biliary tract and lymphatic system, which included external drainage of the thoracic duct, endoscopic papillosphincterotomy and lymphovenous anastomosis. The mortality rate in the control group was 23.2%, of which 8% of patients with jaundice duration up to 10 days, 45% — with jaundice duration up to 14 days. In the main group, the overall mortality was 5.5%, which is 4.2 times lower than in the control group. Of those with a duration of cholestasis up to 10 days, there was no mortality, in patients with a duration of biliary occlusion up to 14 days, it was 7% and in patients with a duration of up to 3–6 weeks — 15%. According to the indications, lymphovenous anastomosis was performed in 39 patients; there was no mortality cases among these patients. During the study, it was confirmed that lymphatic drainage operations in combination with endoscopic biliary decompression help to reduce porto-lymphatic pressure, sanitize the biliary tract, reduce endogenous intoxication and improve treatment outcomes.