Interventional radiology in the prevention of bile duct anastomotic stricture during reconstructive surgery for the iatrogenic bile duct injury (one center experience)

Abstract

Aim . To study the possibility of using radiological interventions in the staged treatment of intraoperative bile ducts injury and the prevention of biliodigestive anastomotic stricture. Materials and methods . A retrospective analysis of the treatment of 20 patients with “large” (classes B—E) iatrogenic damage to the extrahepatic biliary tract was performed. In all cases, percutaneous transhepatic cholangiostomy was performed before reconstructive Roux-en-Y hepatico- or bighepaticojejunostomy. Biliary drains installed before surgery were retained to control the anastomosis in the early postoperative period, as well as for 6 months for possible correction of the forming narrowing. Preoperatively established biliary drains were retained to control the anastomosis in the early postoperative period, as well as for 6 months for possible correction of the anastomotic stricture. Results . In 2 cases with a B-class injury, it was possible to restore the patency of the common hepatic duct by balloon dilatation without subsequent reconstructive surgery. Roux-en-Y hepatic or (bihepatico)-jejunostomy was performed in 18 patients. In 10 cases antegrade interventional radiological reconstruction of the common bile duct was performed on the external-internal drainage, including 4 cases with partial excision of the common bile duct (class E). Temporary (6 months) antegrade stenting of the partially excised right lobe duct and the confluence zone was performed in 2 cases with trauma classes D and E. There were no lethal outcomes or complications of interventional radiological surgery. Narrowing of the anastomosis was avoided in all patients. The follow-up period varied from 6 months to 13 years. Conclusion . Regardless of the period of detection of biliary tract injury in the postoperative period, tactics of stage treatment, involving the drainage of the biliary tree, with subsequent endoscopic or radiologic intervention, are advisable. Percutaneous biliary drainage in case of “large” iatrogenic injuries of the bile ducts in the postoperative period makes it possible to control biliodigestive anastomosis, timely detect and adequately correct its stricture.