”Rapid” biliary decompression syndrome in obstructive jaundice surgery
Abstract
Objective. To improve the outcomes in patients with obstructive jaundice by well-timed prognosis, early diagnosis and effective treatment of “rapid” biliary decompression syndrome.
Material and methods. The outcomes in 5792 patients with obstructive jaundice for the period 2007–2018 were analyzed. There were 7179 minimally invasive drainage procedures including 5013 (69,8%) endoscopic transpapillary interventions, 288 (4,0%) percutaneous transhepatic procedures and 1878 (26,2%)combined interventions. Incidence of postoperative complications including “rapid” biliary decompression syndrome and mortality rate were analyzed.
Results. Twelve patients died due to progression of hepatic failure (n = 5) and hepatorenal syndrome (n = 7). “Rapid” biliary decompression in early postoperative period was diagnosed in 11 patients. Clinical and laboratory prognostic criteria and signs of “rapid” biliary decompression syndrome were proposed using calculation of biliary decompression rate and decrease of bilirubin level. A treatment algorithm was developed.
Conclusion. Preoperative biliary drainage in patients with severe obstructive jaundice can result “rapid” biliary decompression syndrome. Clinical manifestations of this syndrome include various symptoms (hepatic failure, hepatorenal syndrome, hepatic encephalopathy and coagulopathy) and their combination that requires emergency management.
Material and methods. The outcomes in 5792 patients with obstructive jaundice for the period 2007–2018 were analyzed. There were 7179 minimally invasive drainage procedures including 5013 (69,8%) endoscopic transpapillary interventions, 288 (4,0%) percutaneous transhepatic procedures and 1878 (26,2%)combined interventions. Incidence of postoperative complications including “rapid” biliary decompression syndrome and mortality rate were analyzed.
Results. Twelve patients died due to progression of hepatic failure (n = 5) and hepatorenal syndrome (n = 7). “Rapid” biliary decompression in early postoperative period was diagnosed in 11 patients. Clinical and laboratory prognostic criteria and signs of “rapid” biliary decompression syndrome were proposed using calculation of biliary decompression rate and decrease of bilirubin level. A treatment algorithm was developed.
Conclusion. Preoperative biliary drainage in patients with severe obstructive jaundice can result “rapid” biliary decompression syndrome. Clinical manifestations of this syndrome include various symptoms (hepatic failure, hepatorenal syndrome, hepatic encephalopathy and coagulopathy) and their combination that requires emergency management.
About the Authors
Yu. V. Khoronko
Rostov State Medical University
Russian Federation
Russian Federation
Doct. of Sci. (Med.), Professor, Head of the Chair of Operative Surgery and Topographic Anatomy, Surgeon of the Surgical Department
Phone: +7-938-100-04-83
29, Nakhichevanskiy str., Rostov-on-Don, 344022; Russian Federation
V. L. Korobka
Rostov Regional Clinical Hospital,
Rostov State Medical University
Russian Federation
Russian Federation
Doct. of Sci. (Med.), Chief Physician, Associate Professor of the Chair of Surgical Diseases of Faculty of Post-Qualifying Education
29, Nakhichevanskiy str., Rostov-on-Don, 344022; Russian Federation190, Blagodatnaya str., Rostov-on-Don, 344015; Russian FederationV. S. Groshilin
Rostov State Medical University
Russian Federation
Russian Federation
Doct. of Sci. (Med.), Professor, Head of the Chair of Surgical Diseases №2
29, Nakhichevanskiy str., Rostov-on-Don, 344022; Russian Federation
S. V. Tolstopyatov
Rostov Regional Clinical Hospital
Russian Federation
Head of the Surgical Department №2
190, Blagodatnaya str., Rostov-on-Don, 344015; Russian Federation
Russian Federation
Head of the Surgical Department №2
190, Blagodatnaya str., Rostov-on-Don, 344015; Russian Federation
I. V. Shitikov
Rostov Clinical Hospital №20
Russian Federation
Russian Federation
Cand. of Sci. (Med.), Head of the Department of X-ray Diagnosis and Introscopy
39, Kommunisticheskiy avenue, Rostov-on-Don, 344091, Russian Federation
References
1. Rukovodstvo po hirurgii zhelchnyh putey [Handbook for biliary surgery]. Edited by E.I. Galperin, P.S. Vetshev. 2ndedition. Moscow: Vidar-M, 2009. 568 p. (In Russian).
2. Galperin E.I., Momunova O.N. The classification of obstructive jaundice severity. Khirurgiya. Zhurnal imeni N.I. Pirogova. 2014;1:5-9. (In Russian).
3. Kulezneva Y.V., Melekhina O.V., Kurmanseitova L.I., Efanov M.G., Tsvirkun V.V., Ogneva A.Y., Musatov A.B., Patrushev I.V. Antegrade cholangiostomy: analysis and prevention of complications. Annaly hirurgicheskoy gepatologii=Annals of HPB surgery. 2018;23(3):37-46. (In Russian). https://doi.org/10.16931/1995-5464.2018337-46
4. Shevchenko Yu.L., Vetshev P.S., Stoiko Yu.M., Levchuk A.L., Kontorshchikova E.S. Priority Trends in the Obstructive Jaundice Patients Management. Annaly hirurgicheskoy gepatologii=Annals of HPB surgery. 2011;16(3):9-15. (In Russian).
5. Galperin E.I. Obstructive Jaundice – a “False Stable” Condition, Consequences of a “Second Hit”, Management Principles. Annaly hirurgicheskoy gepatologii=Annals of HPB surgery. 2011;16(3):16-25. (In Russian).
6. Wang L., Yu W.F. Obstructive jaundice and perioperative management. Acta Anaesthesiol Taiwan. 2014;52(1):22-29. https://doi.org/10.1016/j.aat.2014.03.002
7. Patyutko Yu.I., Kotel'nikov A.G., Dolgushin B.I., Virshke E.R., Kukushkin A.V., Mikhaylov M.M., Kosyrev V.Yu. Zhelcheotvedenie pri mehanicheskoj zheltuhe opuholevogo proishozhdenija [Bile duct decompression in malignant obstructive jaundice]. IV Russian Oncological Conference. Moscow, 2000. P.74–79. (In Russian)
8. Shimizu T., Sato O., Tsukada K. Reestimation of the bilirubin decrease rate “b” (b value) in patients with obstructive jaundice. J. Hep. Bil. Pancr. Surg. 1996;3(1):12-16. https://doi.org/10.1007/BF01212773
9. Tupikin K.A., Kovalenko Yu.A., Vishnevsky V.A. New Options in Prediction of Post-Resection Liver Failure. Annaly hirurgicheskoy gepatologii=Annals of HPB surgery. 2016;21(3):70-74. (In Russian). https://doi.org/10.16931/1995-5464.2016370-74
10. Rahbari N.N., Garden O.J., Padbury R., Brooke-Smith M., Crawford M., Adam R., Koch M., Makuuchi M., Dematteo R.P., Christophi C., Banting S., Usatoff V., Nagino M., Maddern G., Hugh T.J., Vauthey J.N., Greig P., Rees M., Yokoyama Y., Fan S.T., Nimura Y., Figueras J., Capussotti L., Büchler M.W., Weitz J. Posthepatectomy liver failure: a definition and grading by the International Study Group of Liver Surgery (ISGLS). Surgery. 2011;149(5):713–724. https://doi.org/10.1016/j.surg.2010.10.001
11. Long Y., Mi W., Yu W. Anesthesia for Patients with Obstructive Jaundice. J. Anesth. Perioper. Med. 2018;5:149-160. https://doi.org/10.24015/JAPM.2018.0058
12. Pavlidis E.T., Pavlidis T.E. Pathophysiological consequences of obstructive jaundice and perioperative management. Hepatobiliary Pancreat. Dis. Int. 2018;17(1):17-21. https://doi.org/10.1016/j.hbpd.2018.01.008
Review
For citations:
Khoronko Yu.V., Korobka V.L., Groshilin V.S., Tolstopyatov S.V., Shitikov I.V. ”Rapid” biliary decompression syndrome in obstructive jaundice surgery. Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery. 2019;24(4):123-130. (In Russ.)
Views:
15291
Email this article 