Differentiated approach in providing care to patients with fresh bile duct injuries

Abstract

Aim. To demonstrate the efficacy of minimally invasive surgery for bile duct injuries.Materials and methods. The results of combined minimally invasive treatment of 52 patients with fresh bile duct injuries from 2006 to 2023 were analyzed. Bile duct injuries diagnosed within 1–10 days after the operation were referred to as “fresh”. Intraoperative detection of bile duct injury was the criterion of exclusion from the analysis. In 80.8% of observations, combined minimally invasive interventions were performed in the form of percutaneous operations under ultrasound and radiography control. In 19.2% of observations, antegrade percutaneous and retrograde endoscopic access was used.Results. The algorithm for conducting minimally invasive procedures for bile duct injuries and strictures should be selected depending on the terms of injury and the character of injury and complications. In the majority of fresh bile duct injuries, a two-stage algorithm of duct patency restoration was applied. This prevented additional complications and allowed the patient to be prepared for stent biliary drainage after analyzing the primary data of fistula cholangiography. In all observations, minimally invasive procedures of bile duct patency restoration were completed with stent biliary drainage. Complications were noted in eight patients (15.4%).Conclusion. In fresh bile duct injuries, combined minimally invasive methods are an effective alternative to conventional reconstructive surgeries.