Predicting Complications during Minimally Invasive Biliary Tract Decompression

Abstract

Introduction . Obstructive jaundice is one of the most relevant problems in abdominal surgery. The prediction of complications and deaths when using minimally invasive technologies of biliary tract decompression on the basis of objective and reliable criteria will allow this disease to be treated under optimal conditions. Materials and methods . The study was based on the clinical observations and studies of 219 patients with obstructive jaundice, who underwent minimally invasive biliary tract decompression by retrograde and antegrade stenting as the first stage of treatment. Using Statistica 10.0 and MedCalc 12.7.0. software, a retrospective analysis of case histories in 2 groups of patients with and without complications was performed. Results and discussion . The patients were divided into 2 groups: group I — 51 (22.8%) with complications and fatal outcomes in 11 cases, group II — 168 (77%) patients without complications. In group I, external drainage was performed in 23 (45%) patients, and endoscopic stenting in 28 (55%) patients. In group II, external drainage was performed in 73 (43.5%) patients, and endoscopic stenting in 95 (56.5%) patients. Using multivariate ROC analysis, 14 interacting predictors of complications and deaths were identified for minimally invasive interventions of the biliary tract with a significant correlation during the first stage of endoscopic stenting (p < 0.0001). A formula was derived for calculating the prognostic coefficient, for which the values and coordinates of the ROC curve were all values above -1.5635 with a sensitivity of 80.4 and a specificity of 77.4. A software product was created for the formation of risk groups in terms of complications and deaths among patients undergoing minimally invasive biliary tract decompression interventions. Conclusion. Multivariate statistical ROC analysis allows prediction of complications during minimally invasive interventions for biliary tract decompression in 80% of cases. The selection criteria are the location of the tumour, the duration of jaundice and the deviation of the main biochemical parameters from the norm.