X-Ray Surgical Treatment of Benign Strictures of Biliodigestive Anastomosis: Questions for Discussion

Aim.To determine the role of antegrade X-ray surgical interventions in the treatment of benign postoperative biliary strictures.Material and methods.A retrospective analysis of treatment of 36 patients with benign biliary strictures was performed. Isolated stricture of biliodigestive anastomosis was diagnosed in 25 cases, partial clipping of common hepatic duct proximal to biliodigestive anastomosis – in 3 cases, partial clipping of bile duct – in 3 patients, isolated biliary strictures – in 5 patients including 4 of them with stricture within previously deployed T-shaped drainage. At the first stage, percutaneous transhepatic cholangiostomy was performed. According to antegrade cholangiography data, structure type “+1, +2” by H. Bismuth classification in modification of E. I. Galperin was diagnosed in 16 (55.2%) patients, proximal biliary strictures (“0”–“−2”) in 13 patients. Three patients with partial clipping of common bile duct and 4 patients with benign biliary stricture in the area of previously deployed T-shaped drainage were not classified. Recanalization of strictures by “catheter-guide” system was followed by antegrade dilatation of the stricture. Final stage was frame external-internal drainage for 6–12 months with stepwise redo balloon dilatation every 3 months (35 patients). The criterion for the end of minimally invasive treatment was the absence of balloon waist in the stricture zone observed during the next procedure but not earlier than in 6 months from primary balloon dilatation. Surgical correction was indicated for recurrent stricture.Results.Direct technical success was achieved in 35 patients. There was 1 case of recurrent strictures within 1 year among 3 cases of primary repair of biliary strictures in the area of previously installed T-shaped drainage. Resection of common bile duct stricture was followed by Roux-en-Y hepaticojejunostomy. Recurrence-free period among 36 patients ranged from 1 to 10 years, median – 56 months. There were no mortality and complications after X-ray surgery.Conclusion.Antegrade recanalization and balloon dilatation of the stricture followed by long-term external-internal biliodigestive frame drainage are effective for both stricture of biliodigestive anastomosis and partial clipping of bile duct. Conventional surgical procedures should be preferred for cicatricial strictures of extrahepatic bile ducts after previous T-shaped drainage deployment.

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X-ray surgery for benign biliary strictures after cholecystectomy

Охотников

Yakovleva

Горбачева

2019

Ann. hir. gepatol.

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Comparative characteristics of reconstructive surgery and percutaneous balloon dilatation in the treatment of high benign strictures of the bile ducts

et al. 2020

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Aim: to compare the long-term results of various surgical treatment options for patients with high benign strictures of the bile ducts.Materials and methods. From 2012 to 2018, 87 patients with strictures of different levels according to the classification of E.I. Halperinwas observed. A stricture of type «0» was detected in 23 patients, type «−1» in 20, type «−2» in 31, type «−3» in 13 (E3 – 43, E4 – 31, E5 – 13 according to classification Bismuth-Strasberg). Open reconstructive interventions were performed in 63 patients, 24 percutaneous endobiliary ones.Results. Long-term results were traced in 77 (89%) patients, the follow-up period after reconstructive operations was 4.7 ± 1.6 years, after percutaneous – 2.0 ± 1.4 years. Excellent and good results according to the Terblanche classification were achieved in 31 (58%) patients after open reconstructive operations and in 18 (78%) after percutaneous transhepatic biliary drainage.Conclusion. Technically the most difficult for reconstructive and percutaneous interventions on the bile ducts with a high recurrence rate are strictures of types «−2» and «−3» (E4 and E5). A comparative analysis of the long-term results of percutaneous and open interventions showed a statistically significant advantage of percutaneous interventions compared with reconstructive (p = 0.05).

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Interventional radiology in the prevention of bile duct anastomotic stricture during reconstructive surgery for the iatrogenic bile duct injury (one center experience)

et al. 2020

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AEåë÷íûå ïóòè / Bile ductsЦель. Изучить возможность применения радиологических вмешательств в этапном лечении интраоперационной травмы желчных протоков и профилактике сужения билиодигестивных анастомозов. Материал и методы. Проведен ретроспективный анализ лечения 20 пациентов с "большим" (классы B-E) ятрогенным повреждением внепеченочных желчных протоков. Во всех наблюдениях перед реконструктивной гепатико-или бигепатикоеюностомией выполняли чрескожную чреспеченочную холангиостомию. Установленные до операции эндобилиарные дренажи сохраняли для контроля анастомоза в раннем послеоперационном периоде, а также в течение 6 мес для возможной коррекции формирующегося сужения. Результаты. В 2 наблюдениях при повреждении класса В удалось восстановить проходимость общего печеночного протока баллонной дилатацией без реконструктивной операции. Гепатико-или бигепатикоеюностомия выполнена 18 пациентам. В 10 наблюдениях проведено антеградное рентгенохирургическое восстановление общего желчного протока на наружновнутреннем дренаже, в том числе в 4 наблюдениях -при частичном иссечении общего желчного (печеночного) протока (класс Е). В 2 наблюдениях при травме класса D и Е выполнили временное (6 мес) антеградное стентирование частично иссеченного протока правой доли и зоны конфлюенса. Летальных исходов и осложнений рентгенохирургических вмешательств не было. У всех пациентов удалось избежать сужения анастомоза. Сроки наблюдения варьировали от 6 мес до 13 лет. Заключение. Независимо от срока выявления травмы желчных протоков в послеоперационном периоде целесообразно этапное лечение -дренирование билиарного тракта с последующей эндоскопической или рентгенохирургической коррекцией. Антеградное эндобилиарное дренирование при "больших" ятрогенных повреждениях желчных протоков в послеоперационном периоде позволяет контролировать билиодигестивный анастомоз, своевременно выявлять и адекватно корректировать его сужение.Interventional radiology in the prevention of bile duct anastomotic stricture during reconstructive surgery for the iatrogenic bile duct injury (one center experience)

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X-Ray Surgical Treatment of Benign Strictures of Biliodigestive Anastomosis: Questions for Discussion

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X-ray surgery for benign biliary strictures after cholecystectomy

X-ray surgery for benign biliary strictures after cholecystectomy

Comparative characteristics of reconstructive surgery and percutaneous balloon dilatation in the treatment of high benign strictures of the bile ducts

Interventional radiology in the prevention of bile duct anastomotic stricture during reconstructive surgery for the iatrogenic bile duct injury (one center experience)

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