X-RAY SURGERY FOR ”MINOR” BILIARY INJURIES IN CHOLECYSTECTOMY

Aim. To improve the results of minimally invasive treatment of “minor” injuries of the biliary tract during cholecystectomy. Material and Methods. For the period 2010-2016 there were 24 patients with “small” intraoperative damage of the biliary tract during cholecystectomy (Class “A” by Strasberg, 1995). Bile accumulation in gallbladder area was found in 16 cases, external bile leakage through the drain was observed in 8 patients. All 16 patients with subhepatic collection of bile underwent US-assisted drainage with self-locking drainage “pig tail” №8 Fr by Seldinger technique followed by fistulography. In 4 patients with external bile leakage retrograde cholangiopancreatography was made that verified cystic duct stump failure. Also they underwent endoscopic papillosphincterotomy to restore biliary passage into duodenum. Percutaneous transhepatic drainage of non-expanded bile duct was the first step of treatment in four observations. In 2 patients it was definitive treatment of biliary fistula. In two other cases antegrade balloon papillodilatation was performed. Results. In 5 cases external drainage was a final treatment. In 11 cases retrograde cholangiography revealed choledocholithiasis, residual stenosis of major duodenal papilla, that required endoscopic papillosphincterotomy. In 9 of 24 patients (37.5%) temporary external drainage alone or with antegrade papillodilatation were sufficient to eliminate “small” biliary injuries. There were no complications after percutaneous transhepatic cholangiostomy on nonunexpanded ducts and percutaneous drainage of subhepatic biliary collections. Acute postmanipulative pancreatitis developed in 3 of 15 cases after endoscopic papillosphincterotomy. Conservative therapy was successful in all of them. In one case antegrade balloon papillodilatation was accompanied by transient amilazemia without clinical manifestations of acute pancreatitis. Conclusion. Biliary hypertension followed by bile leakage in “minor” biliary injuriesis transient in 37.5% of cases and can be stopped by temporary percutaneous drainage of subhepatic biliary collections and/or temporary cholangiostomy. Balloon dilatation of major duodenal papilla may be also applied additionally.

bile ducts, subhepatic biliary collection, biliary hypertension, external biliary fistula, antegrade cholangiostomy

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