ANTEGRADE BILIARY DRAINAGE SURGERY FOR OBSTRUCTIVE JAUNDICE

Aim. Systematization of experience and improvement of outcomes of minimally invasive biliary drainage surgery for obstructive jaundice.

Materials and Methods. Antegrade biliary drainage surgery was made in 1271 cases including external percutaneous transhepatic cholangiostomy in 977 patients and biliary stenting in 294 patients. 284 (96.6%) patients underwent stenting as the second stage and 10 patients as simultaneous procedure. In 924 (94.6%) patients percutaneous cholangiostomy was performed for malignant tumors, including 667 (72.2%) cases of periampullary tumors, 112 (12.1%) – liver and proximal bile ducts cancer, 135 (14.6%) – progression of other malignancies. In 745 (76.3%) patients percutaneous cholangiostomy was the first stage of treatment. Later on gastropancreaticoduodenectomy was performed in 216 patients and bypasses in 235 patients. Indications for biliary stenting were periampullary tumors in 171 (58.2%) patients, liver and proximal bile ducts cancer in 17 (5.8%) cases and other tumors in 34 (11, 6%) cases.

Results. Complications were observed in 7 (0.7%) patients including 4 cases of procedure-related events. Laparotomy was required in 2 patients. 3 patients developed gastrointestinal bleeding that was stopped conservatively in 2 of them; 1 patient died. 26 (8.8%) patients had complications after biliary stenting including acute pancreatitis in 15 cases and liver failure in 10 patients; 1 patient died from gastrointestinal bleeding. Overall postoperative mortality after percutaneous biliary drainage was 0.16%.

Conclusion. Percutaneous transhepatic biliary decompression is accompanied by comparatively low incidence of complications and mortality. In particular it is caused by improvement of special tools and the use of new materials for endobiliary catheters and stents. More effective use of such high-tech materials and tools requires a certain correction and optimization of treatment approaches

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