X-RAY SURGERY FOR EXTRAHEPATIC BILE DUCTS INJURIES

Aim. To increase efficacy of X-ray surgical treatment of "fresh" bile ducts injuries.

Material and Methods. Antegrade X-ray surgical intervention for iatrogenic bile ducts injuries during cholecystectomy or stomach resection was performed in 12 patients. Bile duct injury has been diagnosed for 5 days after previous surgery. Percutaneous transhepatic biliary drainage was carried out in all cases including 3 patients with non-dilated intrahepatic bile ducts.

Results. Biliodigestive anastomosis with temporary preservation of transhepatic cholangiostomy in postoperative period was carried out in 5 patients with full transection of common bile duct in 1.5–3 months after antegrade transhepatic cholangiostomy. Antegrade recovery of common bile duct by the methods of intervention radiology (transhepatic biliary drainage dislocation in duodenum) was performed in 5 patients. Retrograde endoscopic common bile duct stenting using plastic stent was performed in 2 patients after antegrade biliary drainage. There were no deaths after surgery in this series. Follow-up varied from 3 months to 8,5 years.

Conclusion. Early (within 5 days) iatrogenic bile duct injuries and sufficient surgeon's experience suppose reconstructive surgery with preservation of percutaneous transhepatic biliary drainage that prevents biliodigestive anastomosis failure in postoperative period. Percutaneous transhepatic biliary drainage should be transformed in antegrade biliodigestive stent in case of absence of technical or temporary possibility for early reconstructive surgery. Antegrade biliodigestive stenting combined with retrograde endoscopic stenting or without it should be preferred in surgical management of tangential iatrogenic bile duct injuries. Dissected common bile duct may be also restored using prolonged antegrade biliodigestive stenting.

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