Transfistula antegrade interventions in the treatment of benign biliary strictures

Abstract

Background. Primary reconstructive operations aimed at restoring the passage of bile are rather complicated due to the cicatricial process and in 1530% lead to a distant recurrence of the disease.
 Aim. To present the results of combined X-ray surgery and endoscopic transfistula antegrade interventions in the treatment of benign bile duct strictures.
 Material and methods. For the period from 2011 to 2019 31 patients with benign bile duct strictures were treated in the surgical departments of the City Clinical Hospital No. 14 in Yekaterinburg. The mean age of the patients was 60.312.7 years, the comorbidity index was 2.6. As follows from the presented data, in 13 patients the stricture developed in the area of biliodigestive anastomoses. Another 17 patients had stricture after surgery for cholelithiasis. In 1 case, there was a persistent narrowing of the lumen of the choledochus against the background of indurative pancreatitis. In 25 (80.6%) cases, the first step was percutaneous transhepatic cholangiostomy under ultrasound guidance. Another 6 (19.4%) patients had a T-shaped drainage of the choledochus.
 Results. For the treatment of strictures of the bile ducts, 97 operations were performed: an average of 3.1 operations per 1 patient. Lithoextraction with a wire basket was performed in 17 patients with calculi. 5 patients with stones larger than 10 mm required contact lithotripsy. Stricture was confirmed in 25 patients. Balloon dilatation was performed in 21 cases. In 8 cases, dilatation was supplemented with papillosphincterotomy. In 6 patients with deformation of the anastomosis zone, framed drainage was installed for 12 months. In 3 patients, bilioduodenal stenting with a nitinol stent was performed. It was not possible to recanalize the stricture in 4 (13%) cases. Complications were registered in 1 (3.2%) patient (IIIB degree according to ClavienDindo).
 Conclusion. Transfistula cholangioscopy is an effective endoscopic technology in the treatment of patients with benign bile duct strictures.