DIAGNOSTICS AND SURGICAL TREATMENT OF POSTTRAUMATIC CICATRICIAL STRICTURES OF THE EXTRAHEPATIC BILE DUCTS
Summary. The aim of the work is to improve the results of surgical treatment of iatrogenic injuries of the extrahepatic bile ducts.
Materials and methods. The experience of treating 362 patients with iatrogenic injuries of the extrahepatic bile ducts, obtained mainly in other hospitals over the past 18 years, is presented. In the clinic, these patients are reoperated. Among them were 258 (71.3 %) women and 104 (28,7 %) men aged 20 to 80 years.
Results and discussion.Damage and stricture of the bile duct were noted during laparotomic (299) and laparoscopic (63) cholecystectomy. Damage to the hepatic duct was seen in 235 patients, choledochus — in 127. The main research methods were: percutaneous transhepatic cholangiography, endoscopic retrograde cholangiopancreatography, fistulocholangiography. In the clinic, all 362 patients were operated. In 47 of them were performed restorative operations, and in 315 of them were performed reconstructive ones. At the first stage (until 2004), restorative and reconstructive operations (with transhepatic frame drainage) were used more often. At the 2nd stage (since 2005), the operation of choice was a high hepaticoduodenostomy in 2 modified versions. Over the past 7 years, the number of postoperative complications has been reduced by 8,3 %, mortality from 6,8 to 1,5 %.
Conclusions. The operation of choice in case of complete damage to the bile duct is the formation of a high hepaticojejunoanastomosis according to our modified methods. Reconstructive operations are indicated only in case of partial damage to the bile duct. A multidisciplinary approach to the correction of duct damage is advisable, which should be carried out in specialized surgical hepatological centers. The use of modified methods of reconstructive surgery contributed to a decrease in postoperative complications by 8,3 % and mortality by 5,3 % (95 % CI, p <0.05).
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