TREATMENT OF PATIENTS WITH CENTRAL AND PROXIMAL OBSTRUCTIONS OF THE BILIARY TRACT
A.Z. ABDULLAYEVA , R.T. MAJIDOV, E.P. MAMEDOVA
Daghestan State Medical Academy, Makhachkala, RUSSIA
Introduction. The central and proximal obstructions of the biliary tract (BT), are mainly conditioned by cancer of gallbladder and bile duct at the bifurcation level, and rarely, post-traumatic strictures of the ducts. In case of distal obstruction of BT, in most cases, there is an opportunity to carry out the decompression of the BT through the formation of cholecystostomy in minimally invasive variant, and in two other higher obstructions, there is no such possibility due to the exclusion of the bladder from the process bile disposal.
Materials and methods. Results of treatment of 108 patients with central and proximal tumor obstruction of BT are presented. In 52 observations there was carried out percutaneous transhepatic decompression of BT, and 56 interventions from a wide laparotomy, such as: choledochotomy, duct recanalization of in the area of tumor obstruction, external drainage of BT - 27 (48.2%), choledochotomy, biliary stenting - 4 (7.1%), resection of the bile duct, biliodigestive anastomoses - 8 (14.3%), cholecystectomy, external drainage of BT 7 (12.6%).
Results and discussion. In the group of patients (56), which were performed BT decompression from a wide laparotomy, no intraoperative complications were observed. Postoperative complications were observed in 5 (8.9%) patients: bile disposal into subhepatic space, fully caught by a safety drainage in 3 cases and with the development of bile peritonitis in 2. 2 patients were performed repeated operation, fatal outcome occurred in 1 (1.8%) case. In the comparison group (52 cases with percutaneous transhepatic decompression of BT) intraoperative complications were not observed. Postoperative complications were observed in 3 (5.7%) patients: hematobilia in 2 cases, migration of the catheter in - 1. Laparotomy and external drainage of BT in connection with the development of bile peritonitis were performed in 1 (1.9%) patient. Fatal outcomes in the immediate postoperative period were not observed in this group of patients.
Conclusions. In case of high tumor obstruction of BT, transhepatic percutaneous decompression of BT under radiographic-television or ultrasound guidance is the most preferred treatment. In the case when it is impossible - external or internal drainage of BT from a wide laparotomy.
MANAGEMENT OF CHOLEDOCHAL CYSTS
Mansoura University, Mansoura, EGYPT
Background and study aim : Choledochal cyst disease is rare but represents a challenge for hepato-biliary surgeons. I report on my center's experience with this disease with special regard to presentation, treatment and results.
Patients and methods: Between June 1991 and September 2010, 38 patients
( 28 females and 10 males; the mean age was 21±17 years) with choledochal cysts were managed at Gastroenterology Surgery center, Mansoura University, Egypt. Cyst excision with hepatico – jejunostomy was done for 33 patients (86.8%), left hepatectomy for 2(5.3%) and left hepatectomy , cyst excision and right hepatico- jejunostomy for 3( 7.9%). Patients were followed up for 6 months – 19 years ( 5.5± 4.4 years ).
Results: The hospital stay was 3-31 days ( 7.6± 5.2 days ). There was no operative mortality. Late mortality occurred in one patient (2.6%), who had type I cyst complicated by cholangiocarcinoma and died at home 2 years after resection from undefined cause. Postoperative morbidity occurred in 10 patients ( 26.3%). Five patients ( 13.2% ) had localised bile collection that was managed by ultrasound guided tube drainage . Anastomotic stricture occurred in 3 cases ( 7.9%).Pancreatitis occurred in one case ( 2.6%) .Pancreatic duct injury, pancreatic leakage and secondary haemorrhage occurred in one case( 2.6%).
Conclusions: Choledochal cysts could be seen in adults. Cholangiography is essential to avoid misdiagnosis. Excision is the treatment of choice to avoid the risk of complications.