Preoperative biliary drainage for malignant biliary obstruction: to drain or not to drain? And if drain, in what way?

Шабунин, А. В.; Лебедев, С. С.; Тавобилов, М. М.; Bagatelia, Z.A.; Греков, Д. Н.; Карпов, А. А.; Afanasieva, V.A.

doi:10.17116/hirurgia2021051101

Cited by 2 publications

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References 30 publications

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“…Tactical approaches and decisions in the treatment of patients with malignant neoplasms of BPDZ complicated OJ have undergone certain changes in the last few decades. Surgical treatment performed on patients with blastomatous jaundice result in large number of complications, and mortality can reach 15-60 % [9]. The unsatisfactory results of general surgical treatment performed in any OJ complicated cases dictate the need to perform a two-stage treatment where decompression of BPDZ in order to restore the natural bile passage.…”

Section: Introductionmentioning

confidence: 99%

Implementation of mini-invasive methods of bile drainage in the treatment of blastomatous mechanical jaundice

Kosulin

2021

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Tumor diseases of the BPDZ (biliopancreatoduodenal zone) occupy one of the leading places among the causes of disability and mortality of the population, both according to global and domestic statistics, while in 85–90 % of cases, patients with distal tumor biliary obstruction are detected. The most common symptom of malignant tumors of periampullary localization is OJ(obstructive jaundice), which is found in 86–95 % of patients and becomes the first manifestation of the disease in 65–70 % of cases. Purpose. Optimization of surgical treatment in surgically incurable patients with obstructive blastomatous jaundice. Materials and methods. The study was clinical in nature, it was carried out on the basis of CCH №17 (Kharkov, Ukraine) and the State Institution “Institute of General and Emergency Surgery named after V. I. Zaitsev National Academy of Medical Sciences of Ukraine ") and consisted of two stages. The main task of the first stage was a retrospective assessment of the results of antegrade and retrograde minimally invasive interventions performed in the period from 2006 to 2011 in 122 patients. The main objective of the second stage of the study was to assess the results of surgical treatment of 75 patients with blastomatous breast, who were treated from 2012 to 2019. using the developed treatment algorithm. Results. At the first stage of the study, the effectiveness of endoscopic transpapillary and transhepatic biliary excretion methods in patients with distal malignant obstruction of the gastrointestinal tract was compared, for which patients who underwent minimally invasive interventions were divided into two subgroups: group A (63 observations) biliary excretion, and in group b (59 observations) as biliary decompression antegrade percutaneous-transhepatic methods of drainage of bilious ways were applied. Endoscopic transpapillary surgery showed itself to be, not inferior to open surgery in effectiveness of biliary decompression, instead it has a number of advantages, such as low trauma, relative safety, low complication and mortality. Conclusions. The developed algorithm of bile excretion in incurable patients with blastomatous MF allowed to minimize the number of postoperative complications to 4.0 %, to avoid the development of transient hyperamylasemia and postmanipulation pancreatitis. Endoscopic retrograde methods of RV prosthetics as the final stage of surgical treatment in this category of patients have certain advantages over antegrade methods of external drainage, primarily due to the preservation of the natural passage of bile in the duodenum and better adaptation and tolerability by patients

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Section: Introductionmentioning

confidence: 99%

Implementation of mini-invasive methods of bile drainage in the treatment of blastomatous mechanical jaundice

Kosulin

2021

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“…The problem of the restoration of bile adequate passage in case of common bile duct (CBD) obstruction caused by any of various malignant neoplasms of the BPDZ organs remains quite relevant at the present [9,10]. Surgical interventions in patients with jaundice of tumour origin are accompanied by a large number of complications, mortality can reach 15-60 % [11,12]. The unsatisfactory results of general surgical interventions performed in condition of the OJ dictate the need for two-stage treatment, where the first stage includes bile ducts decompression to relieve cholestasis [13,14].…”

Section: Introductionmentioning

confidence: 99%

Stage interventions in the treatment of patients with malignant diseases of the common bile duct terminal segment complicated by acute mechanical jaundice

2021

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Obstructive mechanical jaundice is a well-researched complication of various diseases and causes, yet considering patients` condition with malignant diseases according to the stage of the malignant process, severity of complications and etc. Selection of the most appropriate method of surgical treatment is always an option where it is essential to consider finding a way between efficiency and surgical trauma. The aim of the research is to optimize the results of surgical treatment of patients with malignant tumours of the common bile duct terminal segment complicated by acute mechanical jaundice. Materials and methods: patients over 18 y.o. with duodenal obstruction; the presence of other active cancer pathology or blood diseases. The research was performed on 2 different groups divided according to the use of biliary passability restoring method concluding the preferability of minimally invasive methods of bile duct decompression. Results: minimally invasive methods are not inferior to the effectiveness of biliary decompression comparing to open methods, have a number of advantages, such as minimal invasiveness, relative safety, low incidence of complications and mortality Conclusions: the introduction of the developed algorithm for surgical treatment of blastomatous mechanical jaundice with the consistent use of antegrade and open methods, as well as antegrade, retrograde and “rendezvous” techniques in surgically incurable patients allowed to reduce the number of early postoperative complications from 32.7 % to 13.3 %, the number of complications requiring surgery – from 5.8 % to 1.3 % and the level of postoperative mortality – from 11.5 % to 2.7 %.

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Preoperative biliary drainage for malignant biliary obstruction: to drain or not to drain? And if drain, in what way?

Cited by 2 publications

References 30 publications

Implementation of mini-invasive methods of bile drainage in the treatment of blastomatous mechanical jaundice

Implementation of mini-invasive methods of bile drainage in the treatment of blastomatous mechanical jaundice

Stage interventions in the treatment of patients with malignant diseases of the common bile duct terminal segment complicated by acute mechanical jaundice

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