Treatment of patients with high benign strictures of the bile ducts - the experience of one specialized hepatopancreatobiliary center

Abstract

Relevance: Reconstructive surgeries of the bile duct for benign strictures are characterized by unsatisfactory results in 10-30% of patients. Percutaneous and endoscopic interventions are not always effective in cases of stricture recurrence. Materials and methods. From 2012 to 2018 in the Nаtionаl Mediсаl Reseаrсh Center of Surgery were treated 96 patients with benign bile stricture. The age of the patients was between 23 - 82 years, the mean age - 52.9 ± 12. Women - 71 (74%), men - 25 (26%). 53 (55.6 %) patients had a previously formed hepaticojejunostomy. Levels of stricture according to the classification of Bismuth-Strasberg: type E3 - 45, type E4 - 36, type E5 - 15. 72 (75 %) patients underwent hepaticojejunostomy and re HJ, including liver resections: left lateral sectionectomy - 3, right hepatectomy - 2, left hepatectomy - 2. 24 (25%) patients were performed percutaneous transhepatic biliary drainage (PTBD) with balloon dilation. Results: Long-term results were traced in 85 (89%) patients, follow-up periods 4.8 +/- 1.6 years after reconstructive operations. Excellent and good results (according to Terblanche J.) were achieved in 37 (61%) patients who underwent open reconstructive operations and 18 (78%) in patients after PTBD. Conclusion: The best treatment results were observed in patients with preserved confluence - 92% of successful interventions. An independent risk of stricture recurrence a high level of stricture (type E4 - E5 according to Bismuth-Strasberg). Surgical treatment of treatment of benign strictures is the method of choice, with the ineffectiveness of endoscopic and percutaneous transhepatic biliary drainage.