Postoperative Complications Prevention in Surgery for Biliary Opisthorchiasis
https://doi.org/10.16931/1995-5464.2017466-71
Abstract
Aim. To analyze the results of surgical treatment of patients with biliary opisthorchiasis and to develop the complex of pathogenically substantiated measures aimed at preventing complications and unfavorable outcomes.
Material and Methods. The peculiarities of treatment have been studied on the basis of the analysis of medical documentation of 384 patients with opisthorchiasis cholangitis. If peritonitis was absent, the curative program was begun with medication; surgical treatment was performed in 317 (82.6%) patients. Interventions included cholecystectomy (112), external (78) or internal drainage of common bile duct (38), cholecystostomy (93), percutaneous transhepatic cholangiostomy (2), endoscopic balloon dilatation of the sphincter of Oddi (126) and endoscopic papillosphincterotomy (56). The effectiveness of treatment was assessed by the number of complications and deaths.
Results. Surgical activity was 82.6%. Postoperative complications developed in 26 (8.2%) people. According to Clavien–Dindo classification type I was absent, complications type II were noted in 2 (0.6%) cases, IIIa – in 2 (0.6%), IIIb – in 3 (1.0%), IVa – was not observed, IVb – in 1 (0.3%), V – in 18 (5.8%) patients. Postoperative mortality was 5.7%.
Conclusion. In order to improve the outcomes the choice of tactics and surgical techniques should be determined taking into account pathophysiologic and pathomorphological features of biliary opisthorchiasis including chronic biliary hypertension, high incidence of cholangioectasis under the liver capsule and in gallbladder bed, development of sclerosis of ducts and gallbladder walls followed by loss of elasticity and high risk of bile leakage during their drainage, phasicity of the pathological processes in the field of major duodenal papilla and the presence of concomitant chronic disorders of duodenal patency.
Keywords
About the Authors
S. V. Onishchenko
Hospital Surgery Department of the Medical Institute of Surgut State University
Russian Federation
Russian Federation
Cand. of Med. Sci., Associate Professor of the Hospital Surgery Department of the Medical Institute of Surgut State University.
str. Energetikov, Surgut, 628402, Russian FederationV. V. Darvin
Hospital Surgery Department of the Medical Institute of Surgut State University
Russian Federation
Russian Federation
Doct. of Med. Sci., Professor, Head of the Hospital Surgery Department of the Medical Institute of Surgut State University.
str. Energetikov, Surgut, 628402, Russian Federation
References
1. Alperovich B.I., Brazhnikova N.A., Lee A.B. Khirurgiya oslozhneniy opistorkhoza [Surgery of opisthorchiasis complications]. Tomsk: Publishing house of THU, 1990. 224 p. (In Russian)
2. Lyubina V.S. Rol' mikroflory zhelchevyvodyashchikh putey pri opistorkhoze [The role of biliary microflora in opisthorchiasis: abstr. dis. … cand. med. sci.]. Kazan, 1972. 18 p. (In Russian)
3. Tretyakov A.M., Zhukov B.G. Operatsionnaya rentgenomanometriya zhelchnykh putey u bol'nykh s oslozhnennym opistorkhozom. Materialy mezhoblastnoy nauchno-prakticheskoy konferentsii po probleme “Opistorkhoz cheloveka” [Operational x-ray manometry of the biliary tract in patients with complicated opisthorchiasis. Materials of the interregional scientific-practical conference on the problem “Human opisthorchiasis”]. Tomsk, 1979. P. 184–186. (In Russian)
4. Varela G., Siliceo J. Investigation de portadores de bacterias patogenenas intestinalis en vasicular biliares humanas. Rev. inst. salubr. v. enferm. trop. 1956; 16 (4): 25–28.
5. Alperovich B.I., Revskaya A.Yu., Brazhnikova N.A. Biliary strictures management in opisthorchiasis. Khirurgiya. 1983; 8: 40–43. (In Russian)
6. Ziganshin R.V., Bychkov V.G. Biliary hypertension in patients with opisthorchiasis. Vestnik khirurgii im. I.I. Grekova. 1984; 12: 29–33. (In Russian)
7. Ziganshin R.V. Khirurgicheskie oslozhneniya opistorkhoza i ego oslozhneniy [Surgical complications of opisthorchiasis and its complications: abstr. dis. … doct. med. sci.]. Perm', 1977. 32 p. (In Russian)
8. Zubov N.A. Patologicheskaya anatomiya opistorkhoza i ego oslozhneniy [Pathological anatomy of opisthorchiasis and its complications: abstr. dis. … doct. med. sci.]. Sverdlovsk, 1973. 25 p. (In Russian)
9. Ivchenko O.A., Kazantsev N.I. Neprokhodimost' zhelchnykh putey pri opistorkhoze. Tezisy nauchno-prakticheskoy konferentsii [Biliary obstruction in opisthorchiasis. Theses of the scientificpractical conference]. Tomsk, 1977; 64–66. (In Russian)
10. Alperovich B.I., Revskaya A.Yu. Clinic and surgical treatment of biliary strictures due to opisthorchiasis. Vestnik khirurgii im. I.I. Grekova. 1981; 126 (2): 27–30. (In Russian)
11. Brazhnikova N.A., Tskhay V.F. Clinic, diagnosis and treatment of complications of opisthorchiasis. Annaly khirurgicheskoy gepatologii = Annals of HPB surgery. 2004; 9 (2): 40–44. (In Russian)
12. Glebov K.G., Kotovsky A.E. Endoscopic treatment of papillostenosis. Annaly khirurgicheskoy gepatologii = Annals of HPB surgery. 2010; 15 (1): 34–36. (In Russian)
13. Kotovsky A.E., Glebov K.G., Urzhumtseva G.A., Petrova N.A. Endoscopic technologies in the treatment of hepatopancreatoduodenal diseases. Annaly khirurgicheskoy gepatologii = Annals of HPB surgery. 2010; (1): 9–18. (In Russian)
14. Takao Itoi, Atushi Sofuni, Fumihide Itokawa et al. Transnasal endoscopic biliary drainage as a rescue management for the treatment of acute cholangitis. World J. Gastrointest. Endosc. 2010; 2 (2): 50–53.
15. Zubov N.A., Zubkov V.G. Hyperplastic changes of major duodenal papilla in human opisthorchiasis. Arkhiv patologii. 1983; (1): 34–38. (In Russian)
16. Onishchenko S.V., Darvin V.V., Lysak M.M., Shatalov V.G., Novoselov A.I. Pathomorphology of opisthorchiasis papillitis. Vestnik eksperimental'noy i klinicheskoy khirurgii. 2015; 8 (2): 176–185. (In Russian)
17. Onishchenko S.V. Stages of affection in opisthorchiasis papillitis of major duodenal papilla. Vestnik SurGU – Meditsina. 2016; 31 (29): 65–67. (In Russian)
18. Dobrovolsky A.A. Mekhanicheskaya zheltukha pri kholedokholitiaze i opistorkhoze [Mechanical jaundice in choledocholithiasis and opisthorchiasis: abstr. dis. … cand. med. sci.]. Chelyabinsk, 2005. 22 p. (In Russian)
19. Onishchenko S.V. Osobennosti khirurgicheskogo lecheniya oslozhnennykh form opistorkhoza v sochetanii s zhelchnokamennoy bolezn'yu v usloviyakh narushennoy motorno-evakuatornoy funktsii dvenadtsatiperstnoy kishki [Peculiarities of surgical treatment of complicated opisthorchiasis combined with cholelithiasis in conditions of impaired motor evacuation function of the duodenum: abstr. dis. … cand. med. sci.]. Ekaterinburg, 2000. 18 p. (In Russian)
Review
For citations:
Onishchenko S.V., Darvin V.V. Postoperative Complications Prevention in Surgery for Biliary Opisthorchiasis. Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery. 2017;22(4):66-71. (In Russ.) https://doi.org/10.16931/1995-5464.2017466-71
Views:
524
Email this article 