SURGICAL TREATMENT OF IATROGENIC LESIONS OF THE BILIARY TRACT IN PATIENTS WITH CHRONIC OPISTHORCHOSIS

Aim. To determine incidence and causes of iatrogenic injuries of bile ducts during cholecystectomy in patients with chronic opisthorchosis and features of its surgical correction.

Materials and Methods. The results of 7147 cholecystectomies were analyzed. General clinical and modern instrumental methods were used in survey. Statistical analysis was performed using software package Statgraphics 6.0 Plus for Windows.

Results. Bile ducts injuries were observed in 41 (0.57%) patients with gallstone disease including 20 (1.13%) cases with concomitant chronic opisthorchosis and in 21 (0.36%) patients without opisthorchosis. Traditional and laparoscopic cholecystectomy was associated with bile ducts injuries in 0.65% and 0.43% of cases respectively. Large traumas were prevalent (61%) according to the McMachon classification (1995). Pathognomonic pathologic changes of the biliary system and infiltrative changes in the gall bladder neck were main reasons of ducts injuries in case of opisthorchosis and bladder, cholelithiasis, cholecystectomy, iatrogenic lesion, opisthorchosis, bile ducts, drainage, reconstructive surgical procedure. without it respectively. Recovery operations were performed in 55,8% of cases. Reconstructive interventions were performed in 23.3% of patients. Posttraumatic cicatrical strictures of ducts and biliodigestive anastomoses occured 2.6 times more frequent in patients with opisthorchosis. Postoperative mortality was 33.3%, in patients without opisthorchosis – 10.5% (p < 0.05).

Conclusion. Chronic opisthorchosis increases the frequency of duct injuries during cholecystectomy in 3.1 times. The disease complicates technique of recovery and reconstructive operations and increases postoperative mortality.

1. Gallinger Yu.I., Karpenkova V.I. Laparoscopic cholecystectomy: experience of 3165 operations. Endoskopicheskaia khirurgiia. 2007; 13 (2): 3–7. (In Russian)

2. Eremeyev A.G., Golubev A.A., Volkov S.V., Voronov S.N. 13-year experience of laparoscopic techniques in calculous cholecystitis patients management. Novosti khirurgii. 2008; 16 (4): 46–49. (In Russian)

3. Kuzin N.M., Guznov I.G., Kashevarov S.B., Kuznetsov N.A., Safronov P.S., Dadvani S.S. Laparoscopic and traditional cholecystectomy: a comparison of immediate results. Khirurgiia. 2000; 2: 25–27. (In Russian)

4. Archer S.B. Bile Duet injury during laparoscopic cholecystectomy: results of a national survery. An. Surg. 2001; 234 (4): 2001–2007.

5. Connor S., Garden O.J. Bile duct injury in the era of laparoscopic cholecystectomy. Br. J. Surg. 2006; 93: 158–168.

6. Galperin E.I., Chevokin A.Yu. “Fresh” damage to bile ducts. Khirurgiia. 2010; 10: 4–10. (In Russian)

7. Rybachkov V.V., Razdrogin V.A., Gerasimovsky N.V., Kirilyuk A.A., Anosenko S.A., Saygushev A.V., Sheverdov A.P., Popov A.E., Filatov M.S. On the issue of treatment of iatrogenic lesions of extrahepatic biliary tract. Vestnik eksperimental'noj i klinicheskoy khirurgii. 2012; 5 (4): 705–707. (In Russian)

8. Thompson C.M., Saad N.E., Quazi R.R., Darcy M.D., Picus D.D., Menias C.O. Management of jatrogenic bile duct injures role of the interventional radiologist. Radio Graphics. 2013; 33 (1): 117–134.

9. Gorlunov A.V., Kirmas G.A., Kalashnikov I.V. The first experience of percutaneous transhepatic cholangiolitolapaxia with choledoch scar stricture stenting using nitinol selfexpanding stent under ultrasonic and of X-ray control. Endoskopicheskaia khirurgiia. 2013; 1: 256–257. (In Russian)

10. Korolev M.P., Fedotov L.E., Avanesyan R.G. Minimally invasive combined surgery for early and late complications of laparoscopic cholecystectomy. Endoskopicheskaia khirurgiia. 2013; 1: 37–38. (In Russian)

11. Gadiev S.I., Kurbanov E.M. Surgical treatment of iatrogenic damage and scar strictures of the extrahepatic bile ducts. Khirurgiia. 2011; 7: 83–86. (In Russian)

12. Panfilov S.A., Zeynalov S.M., Lebedev S.B. Treatment of “fresh” damage of bile ducts. Endoskopicheskaia khirurgiia. 2012; 4: 23–26. (In Russian)

13. Berney C.R. Major common bile duct injury and risk of litigation: a surgeon's perspective. Am. J. Surg. 2012; 204 (5): 800–802. doi: 10.1016/j.amjsurg.2011.06.009. PMID: 21872206.

14. Artem'yeva N.N., Kokhanenko N.Yu. Treatment of iatrogenic bile duct injury during laparoscopic cholecystectomy. Khirurgiia. 2007; 12: 18–25. (In Russian)

15. Chevokin A.Yu. Technical features of precision anastomosis formation for scar strictures of the biliary tract. Annaly khirurgicheskoj gepatologii. 2011; 16 (3): 79–86. (In Russian)

16. Shapovalyants S.G., Fedorov E.D., Myl'nikov A.G., Marinova L.A., Ardasenov T.B. Endoscopic treatment of postoperative scar strictures of the biliary tract (20-year experience). Annaly khirurgicheskoy gepatologii. 2011; 16 (2): 10–17. (In Russian)

17. Jablonsca B., Lampe P. Iatrogenic bile duct injuries: etiology, diagnosis and management. World J. Gastroenterol. 2009; 7 (15): 4097–4104.

18. Dadhwal U.S., Kumar C.V. Benign bile duct strictures. Med. J. Armed. Forces India. 2012; 68: 299–303. doi: 10.1016/j.mjafi.2012.04.014.

19. Fedorov I.V., Slavin L.N., Chugunov A.N. Povrezhdenija zhelchnyh protokov pri laparoskopicheskoj holecistjektomii [Bile duct injury during laparoscopic cholecystectomy]. Moscow: Triada-H, 2003. 80 p. (In Russian)

20. Martin R.F., Rossi R.L. Bile duct injuries: spectrum, mechanisms of injury, and their prevention. Surg. Clin. North Am. 1994; 74 (4): 781–803.

21. Ozeretsovskaya N.N., Sergiev V.P. Mass treatment of opisthorchiasis with praziquantel from the standpoint of the clinician and epidemiologist. Medicinskaja parazitologija. 1993; 5: 6–13. (In Russian)

22. Bychkov V.G., Krylov G.G., Plotnikova A.O. Opisthorchiasis in the Ob-Irtysh basin (etiology and pathogenesis). Medicinskaja parazitologija i parazitarnye bolezni. 2007; 4: 1–6. (In Russian)

23. Bychkova N.K., Beloborodova E.I. Opistorhoz cheloveka. Jepidemiologicheskie, klinicheskie i farmakologicheskie aspekty [Human opisthorchiasis. Epidemiological, clinical and pharmaco logical aspects]. Tomsk: Print Manufactory, 2012. 168 p. (In Russian)

24. Kabanov M.Yu., Prytula A.E., Yakovleva D.M. Opistorhoznyj holecistit i ego hirurgicheskoe lechenie u lic pozhilogo i starcheskogo vozrasta [Opistorhosis cholecystitis and its surgical treatment in elderly and senile age]. St. Petersburg: ABC Service, 2014. 96 p. (In Russian)

25. Belozerov E.S., Shuvalova E.P. Opistorhoz [Opisthorchiasis]. Leningrad: Medicine, 1981. 128 p. (In Russian)

26. Glumov V.Ya. Opistorhoz (voprosy jepidemiologii, patogeneza, patomorfologii, klinika, lechenie): metodicheskie rekomendacii [Opisthorchiasis (epidemiology, pathogenesis, pathomorphology, clinic, treatment) guidelines]. Izhevsk, 1981. 24 p. (In Russian)

27. Zigan'shin R.V. Khirurgicheskie oslozhnenija opistorhoza [Surgical complications of opisthorchiasis]. Tomsk: STT, 2003. 120 p. (In Russian)

28. Zubkov V.G. Patogenez i morfologija vnutripechenochnyh kholangiojektazov pri opistorhoze [Pathogenesis and morphology of intrahepatic cholangiectasis in opisthorchiasis: dis. ... cand. of med. sci.]. Sverdlovsk, 1973. 248 p. (In Russian)

29. Krylov G.G. Superinvazivnyj opistorhoz: pato- i morfogenez oslozhnennyh form i mikst-patologii [Super invasive opisthorchiasis: patho- and morphogenesis of complicated forms and mixed pathology: author's abstract ... doc. of med. sci.]. Moscow, 2005. 47 p. (In Russian)

30. Alperovich B.I., Brazhnikova N.A., Tskhai V.F., Merzlikin N.V., Tolkaeva M.V., Klinovitskiy I.Yu. Khirurgicheskie aspekty oslozhnennogo i soputstvujushhego khronicheskogo opistorhoza [Surgical aspects of complicated and associated chronic opistorhosis]. Tomsk: TML-Press, 2010. 360 p. (In Russian)

31. Tolkaeva M.V. Ul'trazvukovaja diagnostika hirurgicheskih oslozhnenij opistorhoza [Ultrasound diagnosis of surgical complications of opistorhosis: dis. ... cand. of med. sci.]. Tomsk, 1999. 190 p. (In Russian)