Novosti
Khirurgii
This journal is
indexed in Scopus



Year 2018 Vol. 26 No 1

EXCHANGE OF EXPERIENCE

DOI: https://dx.doi.org/10.18484/2305-0047.2018.1.115   |  

K.M. KURBONOV, U.U. MANSUROV, K.R. NAZIRBOEV

SURGICAL TREATMENT TACTICS OF IATROGENIC LESIONS AND CICATRICIAL STRICTURES OF EXRTAHEPATIC BILE DUCTS

Avicenna Tajik State Medical University, Dushanbe,
The Republic of Tajikistan

Objective. To improve the results of surgical treatment of iatrogenic lesions and cicatricial strictures of extrahepatic bile ducts using timely two-stage treatment tactics.
Methods. The results of surgical treatment of 48 patients with iatrogenic lesions of extrahepatic bile ducts (EBD) in the period from 2004 to 2016 years were analyzed. New damages were observed in 17 (35.4%), scar strictures in 31 (64.6%).
Results. In most cases the causes of lesions were: laparoscopic cholecystectomy 39 (81.2%), traditional cholecystectomy 3 (6.2%) and cholecystectomy from mini-access 2 (4.2%). Overall, cholecystectomy accounted for 44 (91.6%) of the total number of interventions. In other cases, the causes of iatrogenic injuries of EBD were echinococcectomy from the liver in 2 cases, resection of the stomach in 1 and pancreatic necroectomy in one patient. Iatrogenic injuries of EBD occurred in the clinic in 17 (35.4%), but the remaining patients were accordingly transferred from other institutions of the republic. When choosing a treatment strategy and the nature of surgical interventions one considered the time of diagnosis, severity of the patients state, the kind and nature of the iatrogenic lesion or strictures of EBD, as well as secondary complications. In 5 (10.4%) of 17 patients with new EBD injuries, the lesions were diagnosed intraoperatively. In 31 (64.6%) patients, postoperative cicatricial strictures were revealed. These patients were adhered to strictly two-stage therapeutic tactics. Various reconstructive surgeries were performed, including choledochojunoanastomosis on Roux - 9 patients and bihepaticojunoanastomosis on Roux - 15 cases. Of all 48 operated patients, postoperative complications were observed in 6 (12.5%) patients. Postoperative mortality made up 3 patients.
Conclusions. The main type of reconstructive treatment of iatrogenic lesions and cicatricial strictures of EBD are bi-, tri- and Roux hepaticojunoanastomosis on jejunum loop, depending on the localization level of injury or stricture.

Keywords: iatrogenic disease, postoperative cicatricial stricture, extrahepatic bile ducts, cholecystectomy, reconstructive surgical procedures
p. 115-120 of the original issue
References
  1. Barvanian GM, Glukhikh AA. Khirurgicheskoe lechenie iatrogennykh povrezhdenii vnepechenochnykh zhelchnykh protokov posle kholetsistektomii. Vestn Nats Med-Khirurg Tsentra im NN Pirogova. 2010;5(3):57-60. (in Russ.)
  2. Altyev BK, Khadzhiev AM, Shukurov BI. Khirurgicheskoe posobie pri iatrogennom bloke vnepechenochnykh zhelchnykh protokov. Annaly Khirurg Gepatologii. 2007;12(3):36. (in Russ.)
  3. Bystrov SA, Zhukov BN. The surgical tactics in case of bile flow after miniinvasive cholecystoectomy. Med Alm. 2012;(1):90-93. (in Russ.)
  4. Vafin AZ, Delibatov KI. Lechenie striktury vnepechenochnykh zhelchnykh protokov iatrogennogo proiskhozhdeniia. Med Vestn Sever Kavkaza. 2010;17(1):23-28. (in Russ.)
  5. Krasilnikov DM, Farrahov AZ, Kurbangaleev AI. Surgical tactics in iatrogenic injuries of bile ducts. Prakt Meditsina. 2010;(8):20-29. (in Russ.)
  6. Galperin EI, Vetshev PS. Rukovodstvo po khirurgii zhelchnykh putei. Moscow, RF: Vidar; 2009. 568 p. (in Russ.)
  7. Diamantis T, Tsigris C, Kiriakopoulos A, Papalambros E, Bramis J, Michail P, Felekouras E, Griniatsos J, Rosenberg T, Kalahanis N, Giannopoulos A, Bakoyiannis C, Bastounis E. Bile duct injuries associated with laparoscopic and open cholecystectomy: an 11-year experience in one institute. Surg Today. 2005;35(10):841-45.
  8. Costamagna G, Boskoski . Current treatment of benign biliary structures. Ann Gastroenterol. 2013;26(1):37-40.
  9. Rystedt J, Lindell G, Montgomery A. Bile duct injuries associated with 55,134 cholecystectomies: treatment and outcome from a national perspective. World J Surg. 2016 Jan;40(1):73-80. doi: 10.1007/s00268-015-3281-4.
  10. Semenov DIu, Rebrov AA, Vasilev VV, Emelianova NP, Malakhova TV, Bubnova EV, Kamenskaia OV, Bykova AL. Antegradnye endobiliarnye vmeshatelstva pod ultrazvukovym i Rg-kontrolem pri lechenii bolnykh so strikturami zhelchnykh protokov. Uchenye Zap SPb GMU im akad IP Pavlova. 2009;16(3):67-69. (in Russ.)
  11. Shalimov AA, Kopchak VM, Serdiuk VP, Khomiak IV, Dronov AI. Rubtsovye striktury zhelchnykh protokov: nash opyt khirurgicheskogo lecheniia. Annaly Khirurg Gepatologii. 2000;5(1):85-89. (in Russ.)
  12. Maliarchuk VI, Klimov AE, Rao Naresh. Striktury zhelchnykh protokov posle laparoskopicheskoi kholetsistektomii. Endoskop Khirurgiia. 2001;7(3):56. (in Russ.)
  13. Galperin EI, Chevokin AIu. Intraoperative injuries of bile ducts. Khirurgiia Zhurn im NI Pirogova. 2010;(10):4-10. (in Russ.)
  14. Marshall L. Use of retrograde intra-operative cholangiogram for detection and minimization of common bile duct injury. AMSJ. 2010;1:27-29.
Address for correspondence:
734003, The Republic of Tajikistan,
Dushanbe, Rudaki Ave., 139,
Avicenna Tajik State Medical University,
Department of Surgical Diseases 1,
Tel. office: +992 98 555-78-88,
e-mail: surgeon7888@mail.ru,
Mansurov Usmon U.
Information about the authors:
Kurbonov Karimhon M., MD, Professor, Academician of Academy of Medical Sciences of the Republic of Tajikistan, Honored Worker of Science and Technology of the Republic of Tajikistan, Head of the Department of Surgical Diseases 1, Avicenna Tajik State Medical University, Dushanbe, Republic of Tajikistan.
http://orcid.org/0000-0002-8100-9722
Mansurov Usmon U., Post-Graduate Student of the Department of Surgical Diseases 1, Avicenna Tajik State Medical University, Dushanbe, Republic of Tajikistan.
http://orcid.org/0000-0002-3097-9630
Nazirboev Kahramon R., PhD, Assistant of the Department of Surgical Diseases 1, Avicenna Tajik State Medical University, Dushanbe, Republic of Tajikistan.
http://orcid.org/0000-0001-8381-0364
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