X-RAY SURGICAL TREATMENT OF BENIGN STRICTURES OF BILIODIGESTIVE ANASTOMOSIS: QUESTIONS FOR DISCUSSION
https://doi.org/10.16931/1995-5464.2017345-54
Abstract
Aim. To determine the indications and to evaluate the possibilities of antegrade percutaneous biliary interventions for benign strictures of biliary-enteric anastomosis.
Material and Methods. From 2012 to May 2017 sixty five patients with benign strictures of biliary-enteric anastomoses were treated. There were 48 women and 17 men aged 25–82 years. 36 patients had hepaticoenterostomy, 26 patients – double hepaticojejunostomy and 3 patients – triple hepaticojejunostomy. Antegrade intervention consisted of percutaneous puncture of the bile duct, recanalization and balloon dilatation of the stricture with transhepatic drainage tube 8–10 Fr deployment. In the future redo balloon dilatations and exchange of transhepatic drainage tube at 14 Fr have been performed every 2.5–3 months. The procedures were completed if balloon “waist” was not determined during dilatation.
Results. The procedure was technically successful in 97% of patients. Drainage time was 9–24 months. There were 3–8 balloon dilatations per patient. Treatment is over in 27 patients and they are under follow-up. Maximum time after the end of treatment was 32 months. None patient had recurrent stricture at present time. International experts’ opinions about biliary-enteric anastomoses strictures management and technical aspects of antegrade biliary interventions are discussed.
Conclusion. X-ray surgical methods for benign strictures of biliary-enteric anastomosis show long-term efficacy, which exceeds an effectiveness of traditional methods in some cases. However, National Register of Patients with Benign Biliary Strictures was created for data collection and development of uniform management of these patients. Site address: https://www.pbds.info.
About the Authors
Yu. V. Kulezneva
A.S. Loginov Moscow Clinical Scientific Center, Department of Health of Moscow.
Russian Federation
Russian Federation
Kulezneva Julia Valeryevna – Doct. of Med. Sci., Professor of the Department of Surgical Diseases №2 Yevdokimov Moscow State University of Medicine and Dentistry, Head of the Department of Radiation Diagnostic Methods and Treatment of the Loginov Moscow Clinical Scientific Center.
For correspondence: 86, Shosse Enthusiastov, Moscow, 111123, Russian Federation. Phone: +7-903-791-62-55. E-mail: kulezniova@yandex.ru
O. V. Melekhina
A.S. Loginov Moscow Clinical Scientific Center, Department of Health of Moscow.
Russian Federation
Melekhina Olga Vyacheslavovna – Cand. of Med. Sci., Senior Researcher, Department of X-ray-surgical Methods of Diagnosis and Treatment of the Loginov Moscow Clinical Scientific Center.
Russian Federation
Melekhina Olga Vyacheslavovna – Cand. of Med. Sci., Senior Researcher, Department of X-ray-surgical Methods of Diagnosis and Treatment of the Loginov Moscow Clinical Scientific Center.
L. I. Kurmanseitova
Clinic of Endoscopic and Minimally Invasive Surgery, Stavropol State Medical University.
Russian Federation
Kurmanseitova Liana Ibrahimovna – Сand. of Med. Sci., Surgeon of the Clinic for Endoscopic and Minimally Invasive Surgery, Stavropol State Medical University.
Russian Federation
Kurmanseitova Liana Ibrahimovna – Сand. of Med. Sci., Surgeon of the Clinic for Endoscopic and Minimally Invasive Surgery, Stavropol State Medical University.
M. G. Efanov
A.S. Loginov Moscow Clinical Scientific Center, Department of Health of Moscow.
Russian Federation
Efanov Mikhail Germanovich – Doct. of Med. Sci., Head of the Department of Hepatopancreatobiliary Surgery of the Loginov Moscow Clinical Scientific Center.
Russian Federation
Efanov Mikhail Germanovich – Doct. of Med. Sci., Head of the Department of Hepatopancreatobiliary Surgery of the Loginov Moscow Clinical Scientific Center.
V. V. Tsvirkun
A.S. Loginov Moscow Clinical Scientific Center, Department of Health of Moscow.
Russian Federation
Tsvirkun Viktor Viktorovich – Doct. of Med. Sci., Professor, Chief Scientific Officer of the Loginov Moscow Clinical Scientific Center.
Russian Federation
Tsvirkun Viktor Viktorovich – Doct. of Med. Sci., Professor, Chief Scientific Officer of the Loginov Moscow Clinical Scientific Center.
R. B. Alikhanov
A.S. Loginov Moscow Clinical Scientific Center, Department of Health of Moscow.
Russian Federation
Alikhanov Ruslan Bogdanovich – Cand. of Med. Sci., Head of the Department of Liver and Pancreatic Surgery of the Loginov Moscow Clinical Scientific Center.
Russian Federation
Alikhanov Ruslan Bogdanovich – Cand. of Med. Sci., Head of the Department of Liver and Pancreatic Surgery of the Loginov Moscow Clinical Scientific Center.
I. V. Patrushev
A.S. Loginov Moscow Clinical Scientific Center, Department of Health of Moscow.
Russian Federation
Russian Federation
Patrushev Igor Vladimirovich – Resident of the Loginov Moscow Clinical Scientific Center.
For correspondence: 86, Shosse Enthusiastov, Moscow, 111123, Russian Federation. Phone: +7-915-367-09-10. E-mail: igor-patrushev@mail.ru
References
1. Lau W.Y., Lai E.C., Lau S.H. Management of bile duct injury after laparoscopic cholecystectomy: a review. Aust. N. Z. J. Surg. 2010; 80 (1–2): 75–81. DOI: 10.1111/j.1445-2197.2009.05205.x.
2. Galperin E.I. Chto dolzhen delat' khirurg pri povrezhdenii zhelchnyh protokov? 50 lekcij po khirurgii [What should the surgeon do if the bile duct is damaged? 50 lectures on surgery]. Ed. Savelyev V.S. Moscow: Triada-X, 2004. 752 р. (In Russian)
3. Lekcii po gepatopankreatobiliarnoj khirurgii [Lectures for hepatopancreatobiliary surgery]. Eds. Galperin E.I., Dyuzheva T.G. Moscow: Publishing House Vidar-M, 2011. 528 р. (In Russian)
4. Chevokin A.Yu. Technical features of precision anastomoses in cicatrical biliary strictures. Annaly khirurgicheskoy gepatologii. 2011; 16 (3): 79–86. (In Russian)
5. Zepeda G.S., Baron T.N. Benign biliary strictures: current endoscopic management. Nat. Rev. Gastroenterol. Hepatol. 2011; 8 (10): 573–581. DOI: 10.1038/nrgastro.2011.154.
6. Molnar W., Stockum A.E. Transhepatic dilatation of choledochoenterostomy strictures. Radiology. 1978; 129 (1): 59–64.
7. Schumacher B., Othman T., Jansen M., Preiss C., Neuhaus H. Long-term follow-up of percutaneous transhepatic therapy (PTT) in patients with definite benign anastomotic strictures after hepaticojejunostomy. Endoscopy. 2001; 33 (5): 409–415.
8. Weber A., Rosca B., Neu B., Rösch T., Frimberger E., Born P., Schmid R.M., Prinz C. Long-term follow-up of percutaneous transhepatic biliary drainage (PTBD) in patients with benign bilioenterostomy stricture. Endoscopy. 2009; 41 (4): 323–328.
9. Fidelman N. Benign biliary strictures: diagnostic evaluation and approaches to percutaneous treatment. Tech. Vasc. Interv. Rad. 2015; 18 (4): 210–217. DOI: 10.1053/j.tvir.2015.07.004.
10. Ramos A., Misra S., Leroy A.J., Sarr M.G. Management of benign biliary strictures by percutaneous interventional radiologic techniques (PIRT). HPB. 2008; 10 (6): 428–432.
11. Bonnel D.H., Fingerhut A.L. Percutaneous transhepatic balloon dilatation of benign bilioenteric strictures: Long-term results in 110 patients. Am. J. Surg. 2012; 203 (6): 675–683. DOI: 10.1016/j.amjsurg.2012.02.001.
12. Janssen J.J., van Delden O.M., van Lienden K.P., Rauws A.J.R., Busch O.R.C., van Gulik T.M., Gouma D.J., Lameris J.S. Percutaneous balloon dilatation and long-term drainage as treatment of anastomotic and nonanastomotic benign biliary strictures. Cardiovasc. Intervent. Radiol. 2014; 37 (6): 1559– 1567. DOI: 10.1007/s00270-014-0836-y.
13. Cantwell C.P., Pena C.S., Gervais D.A., Hahn P.F., Dawson S.L., Mueller P.R. Thirty years’ experience with balloon dilation of benign postoperative biliary strictures: Long-term outcomes. Radiology. 2008; 249 (3): 1050–1057.
14. Ko G.Y., Sung K.B., Yoon H.K., Kim K.R., Gwon D.I., Lee S.G. Percutaneous transhepatic treatment of hepaticojejunal anastomotic biliary strictures after living donor liver transplantation. Liver Transplant. 2008; 14 (9): 1323–1332.
15. Okhotnikov O.I., Yakovleva M.V., Grigoriev S.N. Interventional radiology of strictures of biliodigestive anastomoses. Khirurgija. Zhurnal im. N.I. Pirogova. 2016; 6: 37–42. (In Russian)
16. Costamanga G., Boškoski I. Current treatment of benign biliary strictures. Ann. Gastroenterol. 2013; 26 (1): 37–40. PMID: 24714594.
17. Liang Y.L., Yu Y.C., Liu K., Wang W.J., Ying J.B., Wang Y.F., Cai X.J. Repair of bile duct defect with degradable stent and autologous tissue in a porcine model. World J. Gastroenterol. 2012; 18 (37): 5205–5210. DOI: 10.3748/wjg.v18.i37.5205.
18. Gwon D.I., Ko G.Y., Ko H.K., Yoon H.K., Sung K.B. Percutaneous transhepatic treatment using retrievable covered stents in patients with benign biliary strictures: Mid-term outcomes in 68 patients. Dig. Dis. Sci. 2013; 58 (11): 3270–3279. DOI: 10.1007/s10620-013-2784-9.
19. Lubienski A., Duex M., Lubienski K., Blietz J., Kauffmann G., Helmberger T. Interventionen bei benignen Gallengangstenosen. Der Radiol. 2005; 45 (11): 1012–1019.
20. Kucukay F., Okten R.S., Yurdakul M. Long-term results of percutaneous biliary balloon dilation treatment for benign hepaticojejunostomy strictures: are repeated balloon dilations necessary? J. Vasc. Interv. Radiol. 2012; 23 (10): 1347–1355. DOI: 10.1016/j.jvir.2012.07.004.
21. Kocher M., Cerna M., Havlik R., Kral V., Gryga A., Duda M. Percutaneous treatment of benign bile duct strictures. Eur. J. Radiol. 2007; 62 (2): 170–174.
22. Vos P.M., van Beek E.J., Smits N.J., Rauws E.A., Gouma D.J., Reeders J.W. Percutaneous balloon dilatation for benign hepaticojejunostomy strictures. Abdom. Imaging. 2000; 25 (2): 134–138.
23. Glas L., Courbiere M., Ficarelli S., Milot L., Mennesson N., Pilleul F. Long-term outcome of percutaneous transhepatic therapy for benign bilioenteric anastomotic strictures. J. Vasc. Interv. Radiol. 2008; 19 (9): 1336–1343.
24. DePietro D.M., Shlansky-Goldberg R.D., Soulen M.C., Stavropoulos S.W., Mondschein J.I., Dagli M.S., Itkin M., Clark T.W., Trerotola S.O. Long-term outcomes of a benign biliary stricture protocol. J. Vasc. Interv. Radiol. 2015; 26 (7): 1032–1039. DOI: 10.1016/j.jvir.2015.03.002.
Review
For citations:
Kulezneva Yu.V., Melekhina O.V., Kurmanseitova L.I., Efanov M.G., Tsvirkun V.V., Alikhanov R.B., Patrushev I.V. X-RAY SURGICAL TREATMENT OF BENIGN STRICTURES OF BILIODIGESTIVE ANASTOMOSIS: QUESTIONS FOR DISCUSSION. Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery. 2017;22(3):45-54. (In Russ.) https://doi.org/10.16931/1995-5464.2017345-54
Views:
1184
Email this article 