Postoperative Complications Prevention in Surgery for Biliary Opisthorchiasis

Abstract

Aim. To analyze the results of surgical treatment of patients with biliary opisthorchiasis and to develop the complex of pathogenically substantiated measures aimed at preventing complications and unfavorable outcomes. Material and Methods. The peculiarities of treatment have been studied on the basis of the analysis of medical documentation of 384 patients with opisthorchiasis cholangitis. If peritonitis was absent, the curative program was begun with medication; surgical treatment was performed in 317 (82.6%) patients. Interventions included cholecystectomy (112), external (78) or internal drainage of common bile duct (38), cholecystostomy (93), percutaneous transhepatic cholangiostomy (2), endoscopic balloon dilatation of the sphincter of Oddi (126) and endoscopic papillosphincterotomy (56). The effectiveness of treatment was assessed by the number of complications and deaths. Results. Surgical activity was 82.6%. Postoperative complications developed in 26 (8.2%) people. According to Clavien–Dindo classification type I was absent, complications type II were noted in 2 (0.6%) cases, IIIa – in 2 (0.6%), IIIb – in 3 (1.0%), IVa – was not observed, IVb – in 1 (0.3%), V – in 18 (5.8%) patients. Postoperative mortality was 5.7%. Conclusion. In order to improve the outcomes the choice of tactics and surgical techniques should be determined taking into account pathophysiologic and pathomorphological features of biliary opisthorchiasis including chronic biliary hypertension, high incidence of cholangioectasis under the liver capsule and in gallbladder bed, development of sclerosis of ducts and gallbladder walls followed by loss of elasticity and high risk of bile leakage during their drainage, phasicity of the pathological processes in the field of major duodenal papilla and the presence of concomitant chronic disorders of duodenal patency.