FEATURES OF SYMPTOMATOLOGY AND SURGICAL TREATMENT OF VARIOUS TYPES OF CICATRICIAL BILIARY STRICTURES

Aim. To reveal features of symptomatology and surgical treatment of different biliary strictures.

Material and Methods. 274 patients (1989–2016) with high cicatrical biliary strictures were analyzed. Type of stricture was defined according to E.I. Galperin classification (2002). Patients with different types of strictures were compared by the number of previous unsuccessful operations, time and severity of cholangitis, presence of biliary liver cirrhosis, features of reconstructive surgery, intraoperative and early postoperative complications and long-term results. 

Results. The most severe group consisted of patients with strictures above the confluence of hepatic ducts: «−1»–«−3» types (137 patients). They underwent previously more than 2 unsuccessful operations, suffered chronic cholangitis with exacerbations for a long time (73% of 137), 10% of them had biliary cirrhosis. Hepp-Couinaud method was required in all patients during hepatic ducts identification. Liver resection was made in 14 (64%) patients with «−3» stricture and 14 (36%) – with «−2» stricture. Stented drainage for biliodigestive anastomosis was used in 31 (50.8%) out of 61 patients with strictures «−2» and «−3». In early postoperative period 4 (1.4%) patients with strictures «−2», «−1», «0» and «+1» died due to multiple organ failure (3) and gastrointestinal bleeding (1). 9 (3.2%) patients underwent redo surgery. Long-term results were followed-up within 1–24 years in 225 (83%) cases and studied in detail in 187 (69%) out of 270 discharged patients. Good and excellent results were observed in 157 (84%) patients. Recurrent stricture developed in 12 patients: 7 with stricture «−1», 1 with stricture «−2», 1 with stricture «−3», 1 with structure «+1» and 2 with stricture «0».

Conclusion. Patients with strictures «−1»–«−3» are the most severe who require complex surgery with liver resection within 4−5 segments to identificate intrahepatic bile ducts. 42 out of 137 (30%) patients of these groups underwent drainage of biliodigestive anastomosis. Stented anastomosis should be used in case of suppurative lesions in the area of anastomosis or if comprehensive excision of all scar tissues and wide area creation are impossible.

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