PERCUTANEOUS MINIMALLY INVASIVE INTERVENTIONS FOR STRICTURES OF BILIODIGESTIVE ANASTOMOSES AFTER BILE DUCTS REPAIR

Aim. To analyze an effectiveness of combined mini-invasive technologies in treatment of strictures of biliary and biliodigestive anastomoses.

Material and Methods. It is presented treatment of 49 patients with strictures of biliodigestive (39) and biliobiliary (9) anastomoses which were made for iatrogenic biliary injury and combined stricture of hepatico- and pancreatojejunostomy after duodenectomy due to cicatricial stenosis. Combined percutaneous interventions were performed. There were 34 women, 15 men. Mean age was 62.7 years.

Results. General principles and approaches for minimally invasive treatment of biliary anastomoses strictures were developed: 1) convenient percutaneous access to the duct, 2) restoration of patency through the stricture of the anastomosis, 3) gradual enlargement of stricture to ensure normal bile dynamics, 4) prolonged (over 24 months) external-internal drainage of the duct and stricture of the anastomosis. In 47 (95.92%) patients interventions were effective. Postoperative morbidity was 14.28% (n = 7) after combined mini-invasive operations: right-sided hydrothorax (2), hemobilia (4), external drainage migration (1). 1 patient died (2.04%) with signs of cholangiogenic sepsis, advanced hepatic-renal failure associated with syndrome of undrained right liver lobe. In 44 patients recurrent strictures were absent within 12–52 months after stented drainage tubes removal.

Conclusion. Minimally invasive percutaneous surgery is effective for strictures of biliodigestive and biliobiliary anastomoses. They provide timely biliary decompression and recovery of adequate bile flow into intestinal lumen. This is achieved by individual approach to drainage technique, gradual enlargement of stricture up to necessary dimension, prolonged external-internal drainage of bile duct and anastomosis for epithelization of its lumen. 

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