CONTROVERSIAL QUESTIONS IN TREATMENT OF IATROGENIC BILE DUCT INJURIES: WAYS OF DECISION
Abstract
Purpose: Iatrogenic bile duct injuries (BDI) is an important problem in abdominal surgery. According to the literature, different methods of surgical reconstruction are performed in patients with BDI. The most frequent procedure is the Roux-en-Y hepaticojejunostomy (HJS) which recommended by most authors.
Materials and Methods: 66 patients with BDI were admitted to our hospital and operated on in period of 1997-2013. Primary end-to-end ductal repair was used in 2 cases in 1-2 days after injury without T-tube drainage and in the third case 5 day after the accident using forenamed drainage. Successful right hemihepatectomy was performed in 1 patient; in 62 patients - Roux-en-Y HJS, 23 among them using our antireflux modification of the anastomosis (Russian Fed. Patent N 2470592).
Results: There were the following criteria for research: wound infection, cholangitis attacks, anastomotic leak, period of time for postoperative blood- and liver function analyses restitution. Total 30-days mortality was 1,5% (1 patient). Mortality wasn’t registered in the group of antireflux interventions. Estimation of follow-up results showed the advantages of the proposal method.
Summary: The method of choice in surgery of iatrogenic BDI and subsequent biliary ductal obstruction due to BDI is repair using antireflux Roux-en-Y HJS.
Materials and Methods: 66 patients with BDI were admitted to our hospital and operated on in period of 1997-2013. Primary end-to-end ductal repair was used in 2 cases in 1-2 days after injury without T-tube drainage and in the third case 5 day after the accident using forenamed drainage. Successful right hemihepatectomy was performed in 1 patient; in 62 patients - Roux-en-Y HJS, 23 among them using our antireflux modification of the anastomosis (Russian Fed. Patent N 2470592).
Results: There were the following criteria for research: wound infection, cholangitis attacks, anastomotic leak, period of time for postoperative blood- and liver function analyses restitution. Total 30-days mortality was 1,5% (1 patient). Mortality wasn’t registered in the group of antireflux interventions. Estimation of follow-up results showed the advantages of the proposal method.
Summary: The method of choice in surgery of iatrogenic BDI and subsequent biliary ductal obstruction due to BDI is repair using antireflux Roux-en-Y HJS.
About the Authors
Yu. V. Khoronko
Rostov State Medical University
Russian Federation
Chair of Operative Surgery and Clinical Anatomy; Department of Surgery
Russian Federation
Chair of Operative Surgery and Clinical Anatomy; Department of Surgery
A. N. Ermolaev
Rostov State Medical University
Russian Federation
Chair of Operative Surgery and Clinical Anatomy; Department of Surgery
Russian Federation
Chair of Operative Surgery and Clinical Anatomy; Department of Surgery
E. Yu. Khoronko
Rostov State Medical University
Russian Federation
Chair of Operative Surgery and Clinical Anatomy; Department of Surgery
Russian Federation
Chair of Operative Surgery and Clinical Anatomy; Department of Surgery
References
1. Бебуришвили А.Г., Зюбина Е.Н., Строганова Е.П., Веденин Ю.И. Осложнения хирургической коррекции ятрогенных повреждений и стриктур желчных протоков // Анналы хирургической гепатологии. – 2008. – Т.13, №3. – С.108-109.
2. Гальперин Э.И., Дюжева Т.Г., Чевокин А.Ю. Операции при рубцовых стриктурах желчных протоков. В кн.: Руководство по хирургии желчных путей.2-е изд./ Под редакцией Гальперина Э.И., Ветшева П.С. – М.: Издательский дом Видар-М, 2009. – 568 с. – С.530-557.
3. Costamagna C., Boškoski I. Current treatment of benign biliary strictures // Ann Gastroenterol. – 2013. –Vol.26, N.1. – P.37-41.
4. Чевокин А.Ю. Повреждения желчных протоков. В кн. Лекции по гепатопанкреатобилиарной хирургии / [Э.И.Гальперин и др.]: под ред. Э.И.Гальперина и Т.Г.Дюжевой. – Москва: Видар-М, 2011. – 536 с. – С.97-122.
5. Imamura M., Takahashi M., Sasaki I., Yamauchi H., Sato T. Effects of the pathway of bile flow on the digestion of fat and the release of gastrointestinal hormones // Am J Gastroenterol. 1988. – Vol. 83. – P. 386-392.
6. Rudnicki M., McFadden D.W., Sheriff S., Fischer J.E. Roux-en-Y jejunal bypass abolishes postprandial neuropeptide Y release // J Surg Res. 1992. – Vol.53 . – P. 7-11.
7. Даценко Б.М., Борисенко В.Б., Зеев А.П. Модификация арефлюксного холедохоеюноанастомоза с восстановлением пассажа желчи в двенадцатиперстную кишку // Международный медицинский журнал. – 2008. – Т.14, №1. – С.102-111.
8. Марков П.В., Оноприев В.И., Фоменко И.В., Григоров С.В. Пластика внепеченочных желчных протков трубчатым аутотрансплантатом из тонкой кишки // Хирургия. Журнал им. Н.И.Пирогов. – 2010. - №11. - С.48-53.
9. Orlando G., Blairvacq J.S., Otte J.B., Goffette P., Ciccarelli O., Sempoux C., Lerut J. Successful treatment of recurrent cholangitis after adult liver transplantation with a Tsuchida antireflux valve // Transplantation. – 2004. – Vol.77, N8. – P.1307-1308..
Review
For citations:
Khoronko Yu.V., Ermolaev A.N., Khoronko E.Yu. CONTROVERSIAL QUESTIONS IN TREATMENT OF IATROGENIC BILE DUCT INJURIES: WAYS OF DECISION. Medical Herald of the South of Russia. 2014;(2):83-87. (In Russ.)
Views:
504
Email this article 