Percutaneous transhepatic cholangiostomy in children

Abstract

Introduction. Congenital malformations of the bile ducts, complicated course of cholelithiasis, strictures of biliodigestive anastomoses, tumors of the pancreatobiliary zone can lead to mechanical jaundice. It is not always possible to perform unloading cholecystostomy for the urgent bile derivation, to stent bile ducts with retrograde endoscopy; more so, to perform radical surgery under hyperbilirubinemia is a risky intervention that can cause complications. Then, percutaneous transhepatic cholangiostomy becomes a method of choice. We present our own experience of interventional surgical procedures on the biliary ducts in children with biliary obstruction.
 Material and methods. 14 patients, aged 6–17 years , who had 47 interventions were included in the study.
 Results. In all cases, percutaneous transhepatic cholangiostomy was successful and stopped biliary hypertension. Stricture recanalization after balloon dilation was successful in 4 patients with hepaticoejunoanastomosis stenosis. Puncture neoanastomosis of the disconnected posterior-sectorial duct was performed in 2 patients. External drainage of the bile ducts with subsequent radical treatment was performed in 10 patients; the “Rendez-vous” technique - in 1 patient.
 Conclusion. Interventional surgical procedures on the bile ducts in children is an effective method of treatment in various clinical situations leading to mechanical jaundice. In some cases, it can effectively stop biliary hypertension. And such methods as recanalization of strictures and puncture neoanastomosis can be a final minimally invasive technique for treating disorders of bile outflow.