Tactics and Surgical Treatment of Obstructive Jaundice of Different Etiology

Abstract

In the department of surgery of the digestive organs of State institution «Institute of gastroenterology of National aca-demy of medical sciences of Ukraine» for the period from 2003 to 2013, 567 patients with pathology of the hepatopancreatobiliary zone of different etiology, complicated with obstructive jaundice, underwent surgery. 197 (34.7 %) patients with bilirubinemia more than 200 µmol/l and III degree of liver failure underwent two-stage treatment. Endoscopic (two-step) techniques were applied for the treatment of 143 (25.2 %) patients with choledocholithiasis. One-step minimally invasive interventions — laparoscopic cholecystectomy, external drainage of the common bile duct, lithoextraction, balloon dilatation of the sphincter of Oddi — implemented in 41 (10.4 %) patients. In complications chronic pancreatitis, draining surgeries were performed in 20 (25.6 %) patients and resection-draining — in 39 (50.0 %), with the correction of bile outflow, as well as endoscopic, laparoscopic and minimally invasive puncture-draining operations were carried out. 2 (2.6 %) patients underwent pancreatoduodenectomy by Whipple. Two-stage surgeries were performed in 26 (33.3 %) patients. At tumors of cholangiopancreatoduodenal zone, 18 (30.5 %) patients underwent percutaneous endobiliary reducing interventions followed by radical surgery in 10 (16.9 %) patients.

Keywords

• obstructive jaundice
• diagnosis
• treatment
• minimally invasive technologies