Minimally invasive and open methods of bile ducts decompression for the treatment of obstructive jaundice

Abstract

Annotation. Obstructive jaundice (OJ) patients account for one of the most challenging categories of patients with abdominal pathologies. Today, both open and minimally invasive bile duct decompression techniques are used in biliary surgery. However, the criteria for the selection of minimally invasive and open surgeries in patients with OJ remain undefined. The aim – assessment of the effectiveness of using minimally invasive and open methods of bile duct decompression for the treatment of OJ with due account to OJ duration, bilirubin count, the age of patients, associated complications and comorbidities. We analyzed the results of the surgical treatment of 250 patients with OJ. Statistical processing of the obtained data was carried out using the Student’s t-test. The average age was 52±6.0 years. The average duration of OJ was 19±3.5 days. Benign OJ was observed in 210 (84.0%) patients, and malignant OJ in 40 (16.0%) patients. 136 (54.4%) patients were submitted to minimally invasive surgical interventions. One-stage minimally invasive interventions were used in 38 (15.2%) cases and two-stage minimally invasive interventions in 98 (39.2%) cases. 114 (45.6%) patients underwent open surgeries. Post-operative сomplications after minimally invasive interventions were observed in 7 (5.2%) cases and 13 (11.4%) cases after open surgeries. 2 (1.7%) patients died. So, the use of minimally invasive surgical interventions for the treatment of OJ patients makes it possible to reduce the frequency of complications by 2.2 times, which is statistically significant (p<0.05). Two-stage surgical approach to the treatment of OJ patients of senior age groups is a priority. Single-stage correction is reasonable to use for young and middle-aged patients with bilirubin count under 200 μmol/l, OJ duration less than 14 days, compensated (sub-compensated) comorbidities, and not burdened by complications.