Disputable issues of biliary drainage procedures in malignant obstructive jaundice
Yu. V. Kulezneva,
O. V. Melekhina,
M. G. Efanov,
R. B. Alikhanov,
A. B. Musatov,
A. Yu. Ogneva,
V. V. Tsvirkun https://doi.org/10.16931/1995-5464.20194111-122
Abstract
Currently, the strategy for preoperative management of patients with malignant obstructive jaundice is not defined. The indications for biliary drainage procedures, the choice of biliary drainage technique and duration of preoperative drainage are still disputable. Analysis of international trials revealed that routine preoperative biliary drainage procedures are not recommended. The indications for biliary drainage in resectable tumors are determined considering severity of obstructive jaundice, cholangitis, dates of major surgery and Bismuth-Corlette tumor type in case of proximal biliary stricture. The choice of retrograde or antegrade preoperative biliary drainage depends on the type of biliary stricture (distal or proximal) and possibilities of medical institution. The majority of studies showed that retrograde (endoscopic) biliary drainage procedures are preferred for distal strictures, antegrade (transhepatic) – for proximal ones. Duration of preoperative biliary drainage depends on normalization of biochemical values. Prolonged drainage may be followed by increased incidence of early postoperative complications. The optimal period of
preoperative biliary drainage is 2 weeks. It is necessary to determine the causes of obstructive jaundice as early as possible for successful treatment. This is also essential to define optimal treatment strategy in certain case. Advisability and certain technique of biliary decompression should be determined in accordance with the chosen treatment strategy.
preoperative biliary drainage is 2 weeks. It is necessary to determine the causes of obstructive jaundice as early as possible for successful treatment. This is also essential to define optimal treatment strategy in certain case. Advisability and certain technique of biliary decompression should be determined in accordance with the chosen treatment strategy.
About the Authors
Yu. V. Kulezneva
Loginov Moscow Clinical Scientific Center of Moscow Department of Health
Russian Federation
Russian Federation
Doct. of Sci. (Med.), Professor, Head of the X-ray Surgical Department
+7-903-791-62-55
86, Shosse Entuziastov, 111123, Russian Federation
O. V. Melekhina
Loginov Moscow Clinical Scientific Center of Moscow Department of Health
Russian Federation
Russian Federation
Cand. of Sci. (Med.), Research Fellow, Surgeon of the X-ray Surgical Department
86, Shosse Entuziastov, 111123, Russian Federation
M. G. Efanov
Loginov Moscow Clinical Scientific Center of Moscow Department of Health
Russian Federation
Russian Federation
Doct. of Sci. (Med.), Head of the Department of Hepato-pancreatobiliary Surgery
86, Shosse Entuziastov, 111123, Russian Federation
R. B. Alikhanov
Loginov Moscow Clinical Scientific Center of Moscow Department of Health
Russian Federation
Russian Federation
Doct. of Sci. (Med.), Head of the Department of Hepato-pancreatobiliary Surgery
86, Shosse Entuziastov, 111123, Russian Federation
A. B. Musatov
Loginov Moscow Clinical Scientific Center of Moscow Department of Health
Russian Federation
Russian Federation
Surgeon of the X-ray Surgical Department
86, Shosse Entuziastov, 111123, Russian Federation
A. Yu. Ogneva
Yevdokimov Moscow State University of Medicine and Dentistry of Ministry of Health of Russia
Russian Federation
Russian Federation
Postgraduate Student of the Chair of Faculty-Based Surgery №2
20/1, Delegatskaya str., 127473, Russian Federation
V. V. Tsvirkun
Loginov Moscow Clinical Scientific Center
of Moscow Department of Health
Russian Federation
Russian Federation
Doct. of Sci. (Med.), Professor, Chief Research Fellow
86, Shosse Entuziastov, 111123, Russian Federation
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Kulezneva Yu.V., Melekhina O.V., Efanov M.G., Alikhanov R.B., Musatov A.B., Ogneva A.Yu., Tsvirkun V.V. Disputable issues of biliary drainage procedures in malignant obstructive jaundice. Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery. 2019;24(4):111-122. (In Russ.) https://doi.org/10.16931/1995-5464.20194111-122
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