Aim. To assess current trends in surgery of benign biliary strictures by using of analysis of long-term results of various biliary interventions performed in the large federal surgical center for a long time. 

Materials and Methods. Surgical treatment of 349 patients with benign biliary strictures has been considered for more than 30 years. Open surgery to restore bile flow was performed in 301 (86%) patients. Percutaneous antegrade transhepatic procedures (balloon dilatation, cholangiostomy) were performed in 48 (14%) patients. Long-term outcomes were estimated in 296 (85%) out of 349 patients. There were 258 patients after open surgery and 38 patients after endobiliary procedures among them.

 Results. Successful results without episodes of cholangitis were achieved in 214 (83%) out of 258 patients. 44 (17%) patients had recurrent stricture within more than 20 year of follow-up. Endobiliary treatment was applied in terms of 6–28 months (mean 17 ± 10 months). In 12 (25%) patients treatment is completed without signs of recurrent stricture (4–24 months of follow-up). 

Conclusion. Further researches including case-control trials are required to develop complete concept of surgical management of benign biliary strictures taking into account the possibilities of percutaneous bile flow restoration.

Aim. To reveal features of symptomatology and surgical treatment of different biliary strictures.

Material and Methods. 274 patients (1989–2016) with high cicatrical biliary strictures were analyzed. Type of stricture was defined according to E.I. Galperin classification (2002). Patients with different types of strictures were compared by the number of previous unsuccessful operations, time and severity of cholangitis, presence of biliary liver cirrhosis, features of reconstructive surgery, intraoperative and early postoperative complications and long-term results. 

Results. The most severe group consisted of patients with strictures above the confluence of hepatic ducts: «−1»–«−3» types (137 patients). They underwent previously more than 2 unsuccessful operations, suffered chronic cholangitis with exacerbations for a long time (73% of 137), 10% of them had biliary cirrhosis. Hepp-Couinaud method was required in all patients during hepatic ducts identification. Liver resection was made in 14 (64%) patients with «−3» stricture and 14 (36%) – with «−2» stricture. Stented drainage for biliodigestive anastomosis was used in 31 (50.8%) out of 61 patients with strictures «−2» and «−3». In early postoperative period 4 (1.4%) patients with strictures «−2», «−1», «0» and «+1» died due to multiple organ failure (3) and gastrointestinal bleeding (1). 9 (3.2%) patients underwent redo surgery. Long-term results were followed-up within 1–24 years in 225 (83%) cases and studied in detail in 187 (69%) out of 270 discharged patients. Good and excellent results were observed in 157 (84%) patients. Recurrent stricture developed in 12 patients: 7 with stricture «−1», 1 with stricture «−2», 1 with stricture «−3», 1 with structure «+1» and 2 with stricture «0».

Conclusion. Patients with strictures «−1»–«−3» are the most severe who require complex surgery with liver resection within 4−5 segments to identificate intrahepatic bile ducts. 42 out of 137 (30%) patients of these groups underwent drainage of biliodigestive anastomosis. Stented anastomosis should be used in case of suppurative lesions in the area of anastomosis or if comprehensive excision of all scar tissues and wide area creation are impossible.

Aim. To evaluate treatment options and long-term results of endoscopic transpapillary interventions for postoperative biliary strictures.

Material and Methods. 83 patients with postoperative biliary strictures underwent endoscopic transpapillary interventions. In all cases strictures were caused by iatrogenic injury of the bile ducts. Strictures type «0» were in 18 (21.7%) cases, «+1» in 37 (44.6%) cases, «+2» in 25 patients (30.1%), «–1» in 3 cases. 

Results. Endoscopic repair of strictures was performed in 64 cases (77.1%) and became final treatment in all of them. Endoscopic management lasted from 8 to 46 months. Time between repeat stenting was 3–4 months. Deployment of two stents was performed in 29 (45.3%) patients, 3 stents – in 9 (14.1%) patients, 4 and 5 stents in 2 and 1 patients, respectively. In 19 (22.9%) out of 83 patients retrograde stenting was failed: in 13 (62%) of 21 patients with strictures type «−1» and «0» and in 6 (9.7%) of 62 patients with strictures type «+1» and «+2», p < 0.01. 16 of 19 patients were further operated. Long-term results were followed-up in 49 (76.5%) patients for the period from 1 to 20 years including 3 patients with strictures «−1» and «0» and 46 patients with strictures type «+1» and «+2». Good, satisfactory and unsatisfactory long-term results were obtained in 42 (85.7%), 4 (8.2%) and 3 (6.1%) patients, respectively.

Conclusion. Endoscopic transpapillary repair of postoperative biliary strictures is technically feasible and provides stable positive result in more than 90% of patients with strictures type «+1» and «+2». Technical possibility and positive results of stenting were achieved in 33% of stricture type «−1» and in 39% of type «0». Unsatisfactory long-term results were observed in 6% of patients and were associated with high extent type of stricture.

Aim. To demonstrate the feasibilities of endoscopic treatment of iatrogenic biliary strictures.

Material and Methods. The series of 14 patients underwent endoscopic treatment of biliary strictures for the period 2014–2016. Treatment protocol included ERCP, balloon or bougie dilation of strictures followed by stenting with several plastic stents. After primary endoscopic procedure all patients underwent step-wise re-stenting procedures with minimal duration of treatment of 12 months.

Results. Technical success rate of endoscopic procedures is 100%. Step-wise endoscopic stenting was completed in 7 out of 10 followed-up patients. Clinical success determined by release of stricture was achieved in 6 out of 7 patients with complete endoscopic treatment. Intraoperative bleeding occurred in one patient that required stenting with SEMS for hemostasis. Recurrent stricture was observed in one patient and required repeated endoscopic procedure.

Conclusion. Endoscopic procedures are effective and safe treatment option for iatrogenic biliary strictures, but more wide studies are needed for appropriate assessment of the results.

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.

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. 

Aim. To study adamethionin effect on liver failure course after extensive liver resection.

Material and Methods. 538 patients after extensive liver resection were included into study. Adamethionin has been used in the main group (326 patients) postoperatively while in the control group (212 patients) hepatoprotective therapy was absent. Incidence and severity of liver failure as well as postoperative complications were analyzed.

Results. Total incidence of post-resection liver failure was 23% (18.7% and 30.2% in the main and control groups respectively, p < 0.05). Mild complications were predominant in the main group while moderate and severe events were observed in the control groups. Post-resection liver failure by “50–50 criteria” was revealed in 27 patients of the control group (12.7%) vs. 13 patients of the main group (4.0%) (p < 0.05). There was significant decrease of ALT and AST activity in the main group compared with the control group postoperatively. Overall incidence of postoperative complications was 18.9% and 17.2% in control and main groups respectively. The incidence of biliary complications was 7.5% and 6.4% in both groups respectively (p > 0.05). Postoperative hospital-stay was 15 (12–28) days in the control group and 11 (9–19) days in the main group (p < 0.05).

Conclusion. Liver failure is possible after extensive liver resections (over three segments). Ademetionin contributes to restoration of liver structure and function, reduces the incidence of liver failure and hospital-stay, provides faster recovery of residual liver parenchyma.

Survival of patients with pancreatic neuroendocrine tumor is determined by many factors. An important role is played by accurate selection of patients for different treatment modalities, that is clearly determined by adequate cancer staging. To date there are two TNM-classifications of pancreatic neuroendocrine tumors which are differ greatly among themselves - European Neuroendocrine Tumor Society TNM-staging system (2006) and American Joint Cancer Committee TNM staging system (2010). We have reviewed the most significant publications related to the analysis of TNM systems accuracy for these tumors. These data suggest that European Neuroendocrine Tumor Society TNM-staging system is superior to the American Joint Cancer Committee TNM-staging system. Considering the low incidence of pancreatic neuroendocrine tumors only further large multi-center studies will improve the staging of these tumors.

Two clinical cases of bleeding from pancreatic duct into duodenum through major duodenal papilla are presented. Brief literature review, anamnesis, features of survey and surgical treatment are described. This complication is a little known and does not have standards for diagnosis and surgical treatment. This disease is characterized by high mortality.

It is presented the case report of successful antegrade X-ray surgical treatment of the patient with iatrogenic injury of hepatic ducts confluens zone during laparoscopic cholecystectomy. There are results of consistent external-internal drainage of common bile duct through the zone of subhepatic biloma, right hepatic duct stenting by covered selfexpanding stent, external drainage of left hepatic duct through the residual cavity of subhepatic biloma and extracorporeal bilio-biliary bypass. Temporary deployment of covered self-expanding metal stent into damaged area in case of full intersection of bile duct allowed to delay safely reconstructive surgery up to 6 months. Long-term result was satisfactory.

It is presented case report of the patient with benign cicatricial stricture (Bismuth II,) caused by thermal trauma of the bile duct (Strasberg D) during laparoscopic cholecystectomy in 1998. Laparotomy followed by external biliary drainage with T-shaped tube were performed. The drain was removed in 35 days after surgery. In 2010 uncovered metal stent was deployed for the stricture of common bile duct. In 2014 covered metal stent was installed in stent-in-stent fashion via antegrade access due to stent occlusion with granulations, cholangitis and mechanical jaundice. Patient's state was satisfactory within 12-month follow-up.