Mechanical Jaundice Research Articles

The role and designation of emergency choledochoscopy in the laparoscopic treatment of patients with complicated choledocholithiasis

Background. The management of patients with cholelithiasis (gallstone disease) and choledocholithiasis who require removal of the gallbladder remains debatable and require urgent actions of the surgeon, especially in cases with concomitant mechanical jaundice. Laparoscopic choledochoscopy is an effective method of examining the bile ducts that allows for the complete removal of calculi, but in the meanwhile, there is not enough information about its effectiveness and sensitivity as part of surgical technology. Purpose: to improve the outcomes of treatment in patients with choledocholithiasis using laparoscopic choledocholithoextraction and choledochoscopy, as well as to assess the diagnostic value of laparoscopic choledochoscopy in bile duct examination and its significance as a component of surgical technology in laparoscopic choledocholithoextraction in patients with gallstone disease. Materials and methods. Between 2018 and 2024, we conducted an analysis of treatment outcomes in 139 patients with gallstone disease and choledocholithiasis, 51 males (36.7 %) and 88 females (63.3 %). The mean age of patients aged 17 to 86 years was 59.5 ± 1.7 years: males — 56.9 ± 1.7 years, females — 62.1 ± 1.7 years. All participants underwent laparoscopic choledocholithoextraction with choledochoscopy. In 29 (20.8 %) patients, choledocholithoextraction and choledochoscopy were performed through the cystic duct, the remaining 110 (79.1 %) people underwent choledocholithotomy with lithoextraction via choledochoscopy. Surgical intervention (laparoscopic choledocholithoextraction and choledochoscopy) was performed using a choledochofiberscope Olympus CHF-V with a diameter of 5 mm and a Karl Storz with a diameter of 3 mm; lithoextraction was done via choledochotomy access with the use of Dormia-type baskets (FG-55D, FG-55D Olympus). Results. All patients underwent bile duct examination via choledochoscopy with mechanical choledocholithoextraction. The first group included 110 (79.1 %) participants who had laparoscopic choledocholithotomy, lithoextraction and choledochoscopy. The second group comprised 29 (20.8 %) patients who underwent choledocholithoextraction and choledochoscopy through the cystic duct. In the first group, on average 3.4 ± 0.4 stones (from 1 to 24) were removed, in the second group — 2.6 ± 0.5 (from 0 to 6). During laparoscopic choledochoscopy with lithoextraction in the first group, bile duct clearance rate amounted to 108 (98.1 %), in the second group — 27 (93.0 %). Bile leakage through the drainage was recorded in 4 (4.5 %) patients from the first group. Endoscopic papillosphincterotomy with lithoextraction was performed in 2 (1.8 %) patients from the first group and 2 (6.8 %) from the second group, due to wedged stones that could not be removed. There were no fatal cases observed. Conclusions. Urgent laparoscopic choledocholithoextraction with choledochoscopy should be applied as one of the technologies for the treatment of gallstone disease and choledocholithiasis, which makes it possible to perform choledocholithoextraction, choledochoscopy with cholecystectomy in one step, while preserving the autonomy of the hepatopancreatobiliary zone and avoiding complications typical for transpapillary interventions.

Metabolic and genetic basis of liver damage in mechanical jaundice of non-tumor genesis in obstractive cholangitis or biliary pancreatitis

Aim. Establishment of versatile mechanisms behind liver damage in mechanical jaundice of non-tumor genesis combined with acute obstructive cholangitis or acute biliary pancreatitis.Materials and methods. In total, 64 cases of mechanical jaundice developed against the background of cholelithiasis were studied. Group 1 included 30 patients with mechanical jaundice combined with cholangitis; group 2 included 34 patients with acute biliary pancreatitis. Bile duct reconstruction was performed by an open method followed by standardized treatment. The intensity of membrane lipid peroxidation was determined by the level of diene conjugates, malonic dialdehyde, superoxide dismutase activity, and the activity of phospholipase A2. The severity of endotoxemia was estimated; a molecular-genetic test of the polymorphism of antioxidant system genes was performed.Results. The significance of the gene polymorphism of antioxidant enzymes in the formation of systemic alterative phenomena and severity of liver damage in mechanical jaundice complicated by cholangitis or acute pancreatitis was determined by allocation of patient subgroups depending on the presence of mutant allele T in the gene of superoxide dismutase SOD2 (C1147T). The groups of patients with the presence of such polymorphism, regardless of the combined diseases, demonstrated more pronounced and prolonged liver functional disorders and homeostasis disorders after restoration of biliary tract patency.Conclusion. The presence of mutant alleles of the SOD2 gene (C47T) in patients with non-tumor mechanical jaundice combined with acute cholangitis or pancreatitis is associated with an increase in the intensity of damage mechanisms at the systemic level, primarily with membrane lipid peroxidation, which correlates with the severity of liver damage (r = 0.834–0.967; p < 0.05).

Віддалені результати радикальних хірургічних втручань із приводу злоякісних новоутворень панкреатодуоденальної зони, ускладнених синдромом механічної жовтяниці

One of the priority tasks of modern oncopancreatology is the involvement of new strategies to improve patient’s survival rates. Aim - to analyze and compare the course of the long-term period after pancreatoduodenal resection in patients with malignant tumors of the pancreatoduodenal zone, complicated by the syndrome of mechanical jaundice. Materials and methods. The long-term results of surgical treatment of 101 patients with malignant neoplasms of the pancreatobiliary area, complicated by the syndrome of mechanical jaundice, were analyzed. The main group included 33 (32.7%) patients in whom pancreatoduodenal resection was combined with extended lymphodissection; the comparison group included 68 (67.3%) patients who underwent a similar operation, but lymphodissection was performed in the standard volume.Variational and non-parametric statistics methods were used. Results. The overall 1-year survival rates of patients in the main group and the comparison group were not significantly different and amounted to 71.3% and 69.2%. Median survival after standard PDR was 15.8 months, after extended - 20.2 months. The overall disease-free 1-year survival rates of patients in the main group and the comparison group did not differ significantly and amounted to 54.1% and 48.3%. Median disease-free survival in the main group was 15 months, and in the comparison group - 12 months. Conclusions. According to the results of the comparative analysis of long-term results, the use of pancreaticoduodenal resection of different lymph node dissection volume in patients of the compared groups did not reveal statistically significant differences in survival. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Pathophysiological features of acute liver failure caused by cholestasis [

Acute liver failure is a syndrome that occurs in 20-59% of patients with liver pathology and is one of the main causes of death in 40% of patients with mechanical jaundice of benign origin and in more than 70% of cases of tumor obstruction of the biliary tract and cancer of caput pancreas. In most cases, the syndrome is a consequence of acute liver damage (viral or drug-induced). Still, it can occur with longterm obstructive jaundice, be the first manifestation of Wilson’s disease, autoimmune chronic hepatitis, or superinfection of the hepatitis D virus against the background of chronic hepatitis B. The aim of the work was to study the pathophysiological features of the development of acute liver failure in patients with bile outflow disorders. The pathogenesis of acute liver failure caused by cholestasis is based on the damage and death of hepatocytes due to impaired blood circulation in the liver, as well as the toxic effect on the parenchyma of both the etiological factors themselves and their metabolites. The first week from the onset of symptoms is very important and usually accompanied by a systemic inflammatory response syndrome with significant consequences. At the same time, the main factors influencing the results of treatment of patients at different points in time are the combination of the critical functional reserve of the liver and the nature and severity of liver damage. In the case of the development of a systemic inflammatory response syndrome, there is a further increase in inflammation, which has a systemic nature and leads to the failure of other organs. Under these circumstances, understanding the pathophysiological features of the course of acute liver failure makes it possible to carry out the necessary diagnostic measures on time and offer appropriate therapy.

ГЕМОСТАТИЧЕСКИЕ НАРУШЕНИЯ ПРИ НЕОПУХОЛЕВОЙ МЕХАНИЧЕСКОЙ ЖЕЛТУХЕ И ХОЛАНГИТЕ В ЗАВИСИМОСТИ ОТ ТЯЖЕСТИ И ПОЛИМОРФИЗМА ГЕНА ФИБРИНОГЕНА

Background. Mechanical jaundice (MF) and cholangitis are considered to be of great significance in emergency surgery due to their complex pathogenesis, risk of complications and high mortality. Objective. To establish the severity of hemostatic disorders in association with fibrinogen gene polymorphism (FGB (G(-455)A)) in patients with non-cancerous MF and cholangitis of varying severity. Material and methods. The subjects were 25 patients with benign MF and cholangitis divided into 2 groups: group 1 (n=12) – those with a mild form of the disease; group 2 (n=13) – those with a severe form. The research methods included the assessment of endogenous intoxication, liver function as well as blood coagulation activity. Genetic analysis of the FGB (G(-455) geneA)) was performed using a polymerase chain reaction by Real–time PCR. The severity of the disease was determined using the V.D. Fedorov scale (2000). Results. The early stage of MF and cholangitis is accompanied by endotoxicosis, resulting in the damage of a number of organs and systems, in particular the liver. The latter plays an important role in changing the activity of blood coagulation system. These disorders had a strong correlation with the severity of the disease: in mild cases, the character was less pronounced and reversible, and in severe cases – persistent and severe. Hemostatic disorders recorded in the early period of the disease depend on the severity: in mild cases, hypercoagulation and normofibrinolysis are noted, and in severe cases – hypocoagulation and hypofibrinolysis. Genetic polymorphism of the fibrinogen gene FGB (G(-455)A) had a significant impact on the pathogenetic process of MF and cholangitis. Patients with the mutant genotype (A/A) of the FGB gene were found to show the greatest severity of homeostasis system violation when compared with patients with genotypes G/G and G/A – with minimal imbalance. Conclusions. Hemostatic disorders associated with polymorphism of the fibrinogen gene FGB (G(-455)A) play an important role in the pathogenesis of MF and cholangitis.

ANTEGRADE METHODS OF BILIARY DECOMPRESSION IN TUMOR OBSTRUCTION OF THE BILIARY TRACT

Percutaneous transhepatic endoscopic ultrasound-guided intervention is a crucial method for addressing mechanical jaundice. This technique for restoring bile outflow enables the resolution of several medical and diagnostic issues with minimal invasiveness and fewer complications compared to traditional open surgical treatments. Most often, antegrade cholangiostomy is used in oncological practice, where the variety of clinical situations determines the indications for performing this intervention in different variants and with different goals. According to the world literature, at the moment, sufficient experience of transdermal technologies has been accumulated, their application in clinical practice has been worked out, which allows to recognize them, to a certain extent, as routine. The purpose of this work is to optimize biliary decompression in patients with tumor obstruction of the biliary tract, to improve the prevention of complications, to enhance the immediate results of treatment and the quality of life for this group of population. The study analyzed the examination and surgical treatment outcomes of 64 patients with tumor-related mechanical jaundice treated in surgical hospitals from 2017 to 2023. All patients underwent antegrade biliary drainage procedures, specifically percutaneous transhepatic cholangiostomy and bile duct stenting under ultrasound guidance, to achieve biliary decompression. Percutaneous transhepatic endoscopic interventions have become the primary method for biliary decompression in cases of bile duct obstruction due to tumors. These procedures, particularly for malignant tumors, are associated with relatively few complications and low mortality rates.

Standards for providing emergency care at the prehospital and early hospital stages for patients with mechanical jaundice

Mechanical jaundice is a condition characterized by obstructive disorders in the biliary system, posing a diagnostic challenge that requires advanced visualization techniques and laboratory tests for accurate diagnosis. This article explores the role of biochemical markers, presents an analysis of the algorithm for laboratory diagnosis and visualization techniques in order to stratify patients with jaundice syndrome, and conduct timely and effective conservative treatment with further surgical interventions. A comprehensive diagnostic and therapeutic algorithm has been developed whose use by emergency physicians at the prehospital and early hospital stages will lead to a rapid and qualitative elimination of biliary obstruction, a reduction in the level of complications, and the achievement of optimal treatment outcomes for patients.

Evaluating the Surgical Treatment of Mechanical Icterus in the General Surgery Department of the Hopital Ntional Ignace Deen, Chu De Conkry

<i>Introduction</i>: The aim of this study was to report our experience in the surgical management of mechanical jaundice. <i>Methods</i>: This was a 10-year retrospective descriptive study (January 2011 to August 2022), carried out in the general surgery department of the Hôpital National Ignace Deen. Patients admitted for surgery for mechanical jaundice were included. <i>Results</i>: We collected 22 cases of mechanical icterus out of a total of 4739 surgical procedures performed during the study period. The mean age was 46 years, with extremes of 9 and 80 years. All our patients were seen at the frank icterus stage. Ultrasound was performed in all patients. Etiologies were dominated by tumors of the pancreatic head (54.54%), and lithiasis of the main bile duct (18.18%). The average consultation time was 5.04 months, with extremes of 9 years and 80 years. Cholecystectomy was performed in over half the cases (54.54%), including three cases associated with stone extraction (13.63%). Bilio-digestive shunts were performed in 11 cases (50%), of the choledochoduodenal (13.63%) and cholecysto-jejunal (13.63%) types. Post-operative management was straightforward in 81.81% of cases, with 4 deaths (18.18%). <i>Conclusion</i>: Palliative bypass, due to the delay in consultation, allows remission of the signs of cholestasis, but does not change the natural course of the pathology. Mortality depends on the etiology.

Complications of minimally invasive methods of mechanical jaundice treatment

The purpose of this study is to evaluate complications after minimally invasive surgical interventions for obstructive jaundice. The statistical analysis of the data of modern Russian and foreign literature sources, as well as the latest scientific works in the field of preoperative preparation of the patient and prevention of postoperative complications in the field of minimally invasive surgical intervention was carried out. The development of these complications represents a fairly wide range of pathological processes, which depends on several indicators directly related to the patient and the operating environment. One of the most important factors is preoperative preparation, which depends on the type of operation, the individual reaction of the patient. Based on the results obtained during the study, it can be concluded that.

Antegrade choledochoscopy in laparoscopic cholecystectomy is a method of diagnosis and treatment of papillostenosis

In the last 30-40 years, there has been a trend in the incidence of cholelithiasis, which, in turn, is often complicated by the development of papillostenosis of various degrees requiring surgical correction. Currently, it is widely used in the diagnosis and treatment of papillostenosis: retrograde choledochopancreatography and endoscopic papillosphincterotomy, but these types of surgical correction of the pathology of large duodenal papilla have a number of disadvantages. In this connection, antegrade choledochoscopy with subsequent augmentation is an option for the diagnosis and correction of papillostenosis narrowing.Aim: of the study is to study domestic and foreign literature on methods of diagnosis and treatment of papillostenosis. To conduct a comparative analysis of the instrumental methods presented in practice, to evaluate the effectiveness of endoscopic antegrade choledochoscopy in papillostenosis.Materials and methods. 31 case histories of a patient who was hospitalized in the Department of Surgery of the Hospital No. 18 from 2013 to 2022 with papilla stenosis complicated by mechanical jaundice, who underwent followed by papillaa ugmentation, were analyzed. A narrowing of the lumen of the papilla of less than 2 mm was considered an indication for antegrade choledochoscopy with buging. The postoperative period in 100 % of patients proceeded without peculiarities. The number of bed-days of hospital stay is 4-6 days, discharged with improvement.Of 100 % of patients - 3.2 % (1 patient) – had a history of papilla restenosis after undergoing laparoscopic cholecystectomy, antegrade choledoscopy and augmentation (4.5 years after the first intervention), he underwent retrograde choledochopancreatography and endoscopic papillosphincterotomy.Conclusion. As presented for 10 years of experience in the use of antegrade choledochoscopy with the bougie of papilla in laparoscopic cholecystectomy, this technique for the diagnosis and treatment of papillostenosis has a large 5-year effectiveness (96.8 %), sensitivity, both due to the optical component of diagnosis and due to the objective component – bougie. In this connection, this method can be used in the practice of a surgeon.

Complications after pylori-preserving pancreatoduodenal resection in a 14-year-old girl with a solid pseudopapillary tumor of the pancreas

Pancreatoduodenal resection (PDR) is one of the most difficult surgical interventions in abdominal surgery of childhood. We present our clinical observation of a postoperative complication in a 14-years-old girl.The girl was operated on for a solid pseudopapillary tumor of the head of the pancreas, laparoscopically assisted pylori-preserving PDR was performed, mobilization and removal of the tumor was performed, distally between the stump of the pancreas and the Roux-en-Y loop of pancreatoejunoanastomo was formed. Mechanical jaundice occurred in the late postoperative period. Percutaneous transhepatic cholangiostomy, recanalization of hepaticoejunoanastomosis with the formation of external-internal transhepatic drainage was performed. 5 courses of balloon dilation of the stricture of the biliodigestive anastomosis were performed later.We demonstrate some complications of PDR in children and show possible options for their correction.

Analysis of surgical treatment of patients with pancreatic cancer at the Samara Regional Clinical Oncological Dispensary

BACKGROUND: Surgery is the only treatment option for tumors of the head and tail. To date, the most optimal operations used for tumors of the head of the pancreas are gastro-pancreatoduodenal resection, and for tumors of the tail — distal subtotal resection of the pancreas and splenectomy. The main access for these operations is median laparotomy. In our article, we analyze the surgical interventions that have been performed for pancreatic cancer in our center, Samara Regional Clinical Oncological Dispensary.
 AIM: Analysis of surgical interventions for pancreatic cancer in the Samara Regional Clinical Oncological Dispensary to assess the immediate and long-term results of surgical treatment.
 METHODS: This article presents the results of treatment of 236 patients with pancreatic cancer in the Department of abdominal Oncology of the Samara Regional Clinical Oncology Dispensary from 2018 to 2023. Most patients underwent surgical interventions, including choledochal stenting, bile duct drainage, and cholecystostomy. In inoperable or unresectable processes, palliative surgery was performed, such as the formation of cholecystoenteroanastomosis and gastroenteroanastomosis. Most of the patients underwent radical surgery, and some of them were preceded by neoadjuvant polychemotherapy. In the postoperative period, various reconstruction methods were performed, including the formation of pancreato-gastro-anastomosis and pancreatoejunoanastomosis. Combined operations were also performed in some patients with tumor invasion of adjacent organs.
 RESULTS: The medical records of 99 patients who underwent radical surgery were examined. 30 of them had significant clinical complications according to the Clavien–Dindo classification and included pancreatic fistula, failure of pancreatoejunoanastomosis, failure of pancreato-gastro-anastomosis and subhepatic abscess. All patients underwent laparotomy, sanitation and drainage of the abdominal cavity, and continued treatment in intensive care units. Some patients required a relaparotomy to stop intra-abdominal erosive bleeding. The mortality rate was 12.02%, the cause of death in some cases was the failure of pancreatoenteroanastomosis together with pancreatic fistula and cardiopulmonary insufficiency caused by pulmonary embolism. The patients were divided into four groups depending on the operation performed. Mortality after distal subtotal pancreatic resection was 2.02%, after.
 CONCLUSION: Surgical intervention is the main method of treating pancreatic cancer. Radical surgery is a key factor that affects the prognosis of the disease. However, the lack of verification of pancreatic cancer before admission to the hospital does not allow chemotherapy to be performed in the mode of preoperative treatment for a common form of the disease. In about 70% of patients, the syndrome of mechanical jaundice becomes the first manifestation of the disease, which requires additional methods of diagnosis and treatment. The complexity of the operation lies in the proximity of the pancreas to vascular structures. Most patients are already inoperable at the time of diagnosis confirmation due to the spread of the tumor process. Due to the technical complexity of operations, the high number of complications and high postoperative mortality, treatment of pancreatic cancer should be carried out in large specialized centers. The treatment of the disease requires interdisciplinary cooperation to achieve optimal diagnosis.

Management of a patient with mechanical jaundice and chronic pancreatitis during pregnancy

Management of a patient with mechanical jaundice and chronic pancreatitis during pregnancy

Retrograde cholangioscopy in differential diagnosis of parasitic invasion

The authors present differential diagnosis of parasitic invasion of the common bile duct. A 52-year-old patient admitted with malignant bile duct obstruction, mechanical jaundice, cholestatic hepatitis and cholangitis. Bile duct tumor was preliminary diagnosed according to anamnesis, complaints, physical, laboratory and instrumental data. Retrograde cholangiopancreatography, endoscopic papillotomy and revision of the common bile duct were performed. There was occlusion at the level of the upper third of the common bile duct. Retrograde cholangioscopy was performed to clarify the nature of obstruction and tumor. Cholangioscopy revealed parasites in the common bile duct that required extraction. The patient was sent to the infectious disease hospital.

Ectopic biliary varices as a cause of portal biliopathy and mechanical jaundice syndrome

The authors consider ectopic biliary varices as a possible cause of portal biliopathy in extrahepatic portal hypertension. The main diagnostic methods including ultrasound CT, MRI, endoscopic ultrasonography, cholangioscopy, difficulties of differential diagnosis and clinical manifestations of portal biliopathy are presented. Various treatment options including portosystemic shunting and endoscopic biliary decompression are discussed. The authors emphasize the role of differentiated treatment depending on bile duct lesions. The study not only reviews this problem, but also highlights the issues requiring further analysis for selection of optimal diagnostic and treatment methods.

The Russian consensus on the treatment of intrahepatic cholangiocarcinoma

The Russian consensus on the treatment of intrahepatic cholangiocarcinoma was prepared by the group of experts consisting of surgeons, interventional radiologists, radiation therapists and oncologists. The purposes of this consensus are clarification and consolidation of opinions of multidisciplinary team on the following issues of management of patients with intrahepatic cholangiocarcinoma: indications for surgical treatment, features of therapeutic tactics for mechanical jaundice, technical aspects of liver resection, prevention of post-resection liver failure, indications for liver resection using transplantation technologies, laparoscopic and robot-assisted liver resection, perioperative systemic chemotherapy, local non-resection/non-radiotherapy methods of treatment, radiotherapy, follow-up and choice of treatment for recurrence.

A personalized approach to the treatment of patients with mechanical jaundice of non-tumor origin ‎

A personalized approach to the treatment of patients with mechanical jaundice of non-tumor origin ‎

МАЛОИНВАЗИВНЫЕ ПОДХОДЫ В ЛЕЧЕНИИ БОЛЬНЫХ ПЕРВИЧНО-МНОЖЕСТВЕННЫМ РАКОМ ГОЛОВКИ ПОДЖЕЛУДОЧНОЙ ЖЕЛЕЗЫ И ЯИЧНИКОВ, ОСЛОЖНЕННЫМ МЕХАНИЧЕСКОЙ ЖЕЛТУХОЙ И КРОВОТЕЧЕНИЕМ, НА ФОНЕ COVID-19 (КЛИНИЧЕСКОЕ НАБЛЮДЕНИЕ)

Often, assuming the presence of an oncological process, it is tumor formation that leads to the development of biliary hypertension. At the same time, the flow of bile is disrupted, pressure increases in the intrahepatic ducts, and mechanical jaundice forms. The intensive introduction of modern high-tech devices into clinical practice has led to a new stage in the development of medicine. Minimally invasive surgical interventions are highly effective, do not require a long recovery period, create a minimal possibility of complications in the postoperative period, and accelerate the patient's recovery. Thus, the use of additional minimally invasive treatment methods (percutaneous transhepatic cholangiostomy with angiography and endovascular embolization of blood vessels) contributed to a faster positive treatment result and allowed the patient to be referred to a specialized hospital for further combined treatment at an early date.

The role of non-invasive preoperative imaging techniques in predicting the risk of pancreatic fistula development in pancreaticoduodenal tumours

Background. In pancreaticoduodenal tumours, pancreaticoduodenectomy (PDE) is a radical surgical intervention. The most important stage of the operation is the pancreaticojejunoanastomosis (PEA), the admissibility of which depends on many factors: the degree of fibrous changes in the pancreatic parenchyma, the degree of mechanical jaundice, and the operating surgeon’s technique. Identification of factors that reflect changes in the structure of the pancreatic parenchyma and its ductal system, which are important predictors in predicting the risk of developing pancreatic fistula (PF) after PDE, is of great scientific importance. Purpose. Evaluation of changes in the structure of the pancreatic parenchyma and its ductal system using non-invasive preoperative imaging methods in predicting the risk of pancreatic fistula development during pancreaticoduodenectomy. Materials and Methods. This study included 302 patients who underwent pancreaticoduodenectomy. Mechanical jaundice was detected in 246 (81.5%) patients, 56 (18.5%) patients had no jaundice, the age of patients ranged from 31 to 77 years, 178 (58.9%) were men and 124 (41.1%) were women. Ultrasound elastography and multidetector computed tomography were used for preoperative non-invasive visualisation of the degree of changes in the pancreatic parenchyma and its ductal system. The following parameters of visualisation of the pancreatic parenchyma with an assessment of the anatomical features of the isthmus and the duct of Wirsung were identified: diameter and cross-sectional area of the duct of Wirsung (at the level of the isthmus), width and thickness of the pancreas (at the level of the isthmus), cross-sectional area of the pancreatic isthmus (without the area of the duct of Wirsung), native density, and stiffness of the pancreatic parenchyma. Results and discussion. The ROC analysis of the parameters for assessing the state of the parenchyma of the pancreas and the duct of Wirsung obtained from computed tomography made it possible to determine the validity of these indicators in predicting the risk of developing PF. According to the results of the ROC analysis, the following indicators were identified as markers of moderate risk of developing PF: the diameter of the duct of Wirsung is less than 4 mm, the cross-sectional area of the duct of Wirsung is less than 0.23 cm2 , the thickness of the isthmus of the pancreas is greater than 15 mm, the width of the isthmus of the pancreas is greater than 19 mm, the cross-sectional area of the isthmus of the pancreas (without the area of the duct of Wirsung) is greater than 3 cm2 , and the native density is greater than 24 HU. To assess the high risk of developing PF, the use of ROC analysis allowed us to establish the high quality of diagnostic models for such computed tomography parameters as the diameter of the duct of Wirsung – the area under the ROC curve is 0.965, the cross-sectional area of the duct of Wirsung – AUC is 0.894, the cross-sectional area of the isthmus of the pancreas (without the area of the duct of Wirsung) – AUC is 0.873, the width of the isthmus of the pancreas – the area under the ROC curve is 0.859, the native density – AUC is 0.844. Determination of the parameter of stiffness of the pancreatic parenchyma by shear wave elastography in predicting high and moderate risk of developing PF also corresponded to the high quality of the diagnostic model. Conclusions. The use of non-invasive imaging methods allows changes in the structure of the pancreatic parenchyma, anatomical features of the pancreatic isthmus and the duct of Wirsung to be detected at the preoperative stage, the risk of developing a pancreatic fistula to be predicted and the number of complications during pancreaticoduodenectomy to be reduced.

PERSONALIZED APPROACH TO THE CHOICE OF BILIARY DRAINAGE TACTICS IN PATIENTS WITH TUMOR-INDUCED MECHANICAL JAUNDICE

Mechanical jaundice resulting from the tumor-induced obstruction of bile ducts is usually the first and quite severe complication of malignant neoplasms of the organs of the hepatopancreatoduodenal zone. Radical treatment for this condition, as reported by various sources, remains below 20-25%. Therefore, the imperative is to select the most effective minimally invasive biliary drainage method to alleviate biliary tract pressure and address the issue of mechanical jaundice. This approach serves both as a preparatory step for potential radical surgical intervention and as a definitive method for palliative treatment in this patient category.
 The aim of this work is to develop an optimal algorithm for diagnosis and treatment of patients with tumor-induced mechanical jaundice, which will increase the effectiveness of primary surgical intervention and reduce the number of complications and mortality for this category of patients.
 The investigation focused on examining the results of diagnostic and surgical interventions in 108 patients with tumor-induced mechanical jaundice. These patients underwent biliary drainage operations in surgical hospitals between 2017 and 2023. Analysis of the surgical outcomes revealed that endoscopic drainage and percutaneous transhepatic drainage exhibited similar effectiveness in I and II levels of biliary obstruction. However, endoscopic drainage demonstrated lower complication rates and improved quality of life for patients, establishing it as the preferred method. For level III blockages, percutaneous transhepatic drainage is recommended.
 The implementation of a diagnostic and treatment algorithm, which considers the level of biliary block, the severity of mechanical jaundice, and the tumor process stage, enables the selection of the most effective minimally invasive biliary drainage method. This approach contributes to a reduction in postoperative mortality.