THE CENTRAL QUESTIONS OF SURGICAL TREATMENT OF CICATRICIAL STRICTURE OF THE BILE DUCTS

Abstract

Aim of the study. To determine causes of recurrent strictures of bile ducts after reconstructive surgical operations and indications for precise and framework biliodigestive anasthomosis.Material and methods. 2 groups of patients were analyzed. Group 1 (1979-1989) consisted of 179 patients, who underwent framework drainage of biliodigestive anasthomosis, group 2 (1990-2008) consisted of 215 patients with precise biliodigestive anasthomosis. Group of patients did not differ from each other according to major clinical parameters.Results. Precise biliodigestive anasthomosis in comparison with framework biliodigestive anasthomosis is associated with less frequency of intraoperative hemorrhage (2,8 vs 5,0%), purulent cholangitis (2,8 vs 13,4%), recurrent strictures (6,4 vs 11,8%) and tendency for diminishing of mortality (2,8 vs 5,0%). No cases of haemobilia was seen in group 2, in group 1 it was detected in 4,5% patients.Conclusion. Precise biliodigestive anasthomosis is one of the most effective and safe approaches to treatment of cicatricial stricture of the bile ducts. The indications for frame drainage is the impossibility of excising all scar tissue, the presence of pus formation in the area created by the anastomosis, liver cirrhosis with portal hypertension.

Keywords

• cicatricial stricture of the bile ducts
• recurrent
• bilodigestive anasthomosis