Anatomical characteristics and clinical rationale of endobiliary surgeries for benign obstructional jaundice

Variants of the anatomical structure of the bile ducts were studied based on endobiliary cholangiography performed in 150 patients who were treated in surgical clinics with a diagnosis of obstructive jaundice of non-tumor etiology, and a retrospective and prospective analysis of the results of their treatment was carried out. The study included the sequence of treatment and diagnostic techniques, the content of preoperative preparation and the alternation of various minimally invasive endobiliary operations. The patients were divided into control and main groups. The control group consisted of 30 patients who were operated on immediately after short-term preoperative preparation; they underwent cholecystectomy, choledocholithotomy with external drainage of the common bile duct. The main group included 120 patients who, along with special preoperative preparation, underwent two- or three-stage surgical interventions on the biliary tract. Various variants of the structure of both extrahepatic and intrahepatic bile ducts were identified, which were taken into account during the surgery and the formation of endobiliary approaches. Decompression of the biliary tract was carried out on the second or third day against the background of active infusion therapy, which continued in the postoperative period. The use of the method of percutaneous transhepatic decompression of the biliary tract using external-internal drainage is possible for any type of bile duct structure. This technique allows to reduce the percentage of postoperative complications from 46% to 23% and reduces the number of deaths from 34% to 11.7%. The use of preoperative preparation and endobiliary drainage methods stabilizes the condition of patients in the preoperative period, relieves the phenomena of cholestasis and cholangitis and allows surgical intervention to be performed under more favorable conditions.

1. Karsanova Z. O. Optimizatsiya taktiki lecheniya bol'nykh s sindromom mekhanicheskoy zheltukhi dobrokachestvennogo geneza, oslozhnennoy kholangitom [Optimization of tactics of treatment of patients with mechanical jaundice syndrome of benign genesis complicated by cholangitis] // Postgraduate Doctor. 2012. 51(2.1). 173-180.

2. Pakhomova R. A. Aktual'nyye problemy diagnostiki mekhanicheskoy zheltukhi v neotlozhnoy khirurgii [Actual problems of diagnosis of mechanical jaundice in emergency surgery] // Postgraduate Doctor. 2012. 52(3.3). 412-417.

3. Bekbauov S. A., Glebov K. G., Kotovsky A. E. Radikal'nyye khirurgicheskiye i retrogradnyye endobiliarnyye vmeshatel'stva posle nazobiliarnogo drenirovaniya u bol'nykh s mekhanicheskoy zheltukhoy [Radical surgical and retrograde endobiliary interventions after nasobiliary drainage in patients with mechanical jaundice] // Journal of Experimental and Clinical Surgery. 2012. 5(3). 569-573.

4. Gabriel S. A., Durleshter V. M., Guchetl A. Ya., Andreev A. V., Dynko V. Yu., Golfand V. V. Retrogradnyye endoskopicheskiye vmeshatel'stva v lechenii bol'nykh mekhanicheskoy zheltukhoy [Retrograde endoscopic interventions in the treatment of patients with mechanical jaundice] // Annals of HPB Surgery. 2015. 20(4). 81-89. DOI: 10.16931/1995-5464.2015481-89

5. Luchevaya diagnostika i maloinvazivnoye lecheniye mekhanicheskoy zheltukhi: rukovodstvo [Radiation diagnostics and minimally invasive treatment of mechanical jaundice: guide]. Eds. L. S. Kokov, N. R. Chernaya, Yu. V. Kulezneva. Moscow, Radiologiya-press Publ., 2010. 259 p.

6. Liu Y.-S., Lin C.-Y., Chuang M.-T., Tsai Y.-S., Wang C.-K., Ou M.-C. Success and complications of percutaneous transhepatic biliary drainage are influenced by liver entry segment and level of catheter placement // Abdominal Radiology. 2018. 43(3). 713-722. DOI: 10.1007/s00261-017-1258-5

7. Wagner A., Mayr C., Kiesslich T., Berr F., Friesenbichler P., Wolkersdörfer G. W. Reduced Complication Rates of Percutaneous Transhepatic Biliary Drainage with Ultrasound Guidance // Journal Clin Ultrasound. 2017. 45(7). 400-407. DOI: 10.1002/jcu.22461

8. Boboev B. D. Rol' endoskopicheskoy ul'trasonografii v diagnostike kholedokholitiaza i vospalitel'nykh striktur zhelchnykh protokov [The role of endoscopic ultrasonography in the diagnosis of choledocholithiasis and inflammatory strictures of the bile ducts] // Grekov's Bulletin of Surgery. 2012. 171(3). 39-41.

9. Borisov A. E., Borisova N. A., Verkhovsky V. S. Endobiliary interventions in the treatment of mechanical jaundice. St. Petersburg, Eskulap Publ., 1997. 146 p.