Management of biliary tract disease based on damage control surgery

Abstract

Acute biliary tract disease has serious threat for the patient life. Emergency surgery for critical patients tends to poor prognosis. Multidisciplinary advantages were integrated and the experiences were summarized in our department which showed that staged treatment of patients with biliary emergency would improve the prognosis greatly. For the patients with acute severe cholecystitis, percutaneous transhepatic gallbladder drainage (PTGBD) was performed first to relieve obstruction and elective surgical treatment was done then, which could reduce significantly the rates of biliary tract injury and postoperative mortality and the rate of intensive care unit admission. It was safer for patients with biliary pancreatitis that firstly PTGBD was performed to relieve the symptoms of pancreatitis, and elective endoscopic sphincterotomy or laparoscopic common bile duct exploration was performed. It is the first to relieve biliary obstruction for the patients of intrahepatic and extrahepatic bile duct stones with bile duct dilatation using endoscopic nasobiliary drainage (ENBD) or percutaneous transhepatic cholangiodrainage (PTCD), which would improve the survival rate greatly. PTCD or ENBD could be used for the patients with malignant tumor in biliary tract to reduce jaundice as early as possible. And then, stent was implanted through PTCD to prolong life.

Keywords

• |damage control surgery|acute cholecystitis|biliary pancreatitis|bile duct stone|cholangiocarcinoma