Percutaneous External Biliary Drainage Research Articles

IS THE ANATOMICAL SEQUENCE OF GASTRIC AND BILIARY ANASTOMOSIS IN THE PANCREATODUODENECTOMY RECONSTRUCTION THE CAUSE OF AN INCREASE IN THE INCIDENCE OF CHOLANGITIS? A TECHNICAL VARIANT PRESENTATION AND INITIAL RESULTS.

ABSTRACT - BACKGROUND:Several methods have been proposed for the reconstruction of digestive transit after pancreatoduodenectomy. Biliary anastomosis positioned before gastric anastomosis helps reduce postoperative reflux and cholangitis.AIMS: The objective of this study was to present the anatomical sequence of gastric and biliary continuity after pancreatoduodenectomy in patients with pancreatic tumor and to evaluate the short- and long-term results in an initial series of cases.METHODS: Two techniques were used: one with Roux-en-Y reconstruction and pancreaticojejunostomy and the other with a single jejunal loop and pancreatogastroanastomosis. In both the cases, the gastric anastomosis was placed performed before the biliary one. An analysis of demographic data, Wirsung’s duct and common bile duct dilatation, the use of percutaneous drainage, and postoperative complications was carried out.RESULTS: A total of seven patients (four men and three women), with a mean age of 62 years, underwent surgery. All cases had Wirsung’s duct and common bile duct dilatation. A percutaneous external biliary drainage was performed in four patients. There were three postoperative complications: one related to delayed gastric emptying and two related to wound infections. During a median follow-up of 12 months, no episode of cholangitis was recorded.CONCLUSIONS: Elevated percentages of cholangitis are reported in different reconstructions after pancreatoduodenectomy, and it is difficult to conclude reflux as the main etiology. The proposed gastric and biliary reconstructions show conforming results, facilitating posterior endoscopic access. Late follow-up and large number of cases may help assess whether the etiology of postoperative cholangitis is reflux or other factors unrelated to the order of the anastomoses.

Minimally invasive surgery for obstructive jaundice caused by malignant tumors

Purpose of the study . On the basis of the accumulated experience to optimize approaches to the preoperative preparation, technical aspects of X-ray surgical antegrade minimally invasive endobiliary interventions, rational postoperative management of patients in order to reduce postoperative complications, improving treatment outcomes and quality of life of patients. Materials and methods . We analyzed 1610 percutaneous transhepatic endobiliary surgeries with separate examination of 1186 X-ray surgical procedures of percutaneous external biliary drainage (PEBD) and 424 cases of antegrade endobiliary stenting (AEBS) Results. Complications after PEBD were developed in 9 (0.76%) patients: the procedure-related bleeding was noted in 3 (0.25%) cases, and bleeding caused by the progression of hepatic failure, hypocoagulation in 6 (0.5%) cases. 3 patients (0.25%) of this group died. Complications after AEBS were registered in 35 (8.3%) patients: acute postoperative pancreatitis in 24 (5.7%) cases, progression of liver failure, hypocoagulation in 9 (2.1%), tumor-induced duodenal stenosis in 2 (0.47%) cases. One patient (0.24%) of this group died. Reduction in complications after PEBD and AEBS is directly associated with surgery techniques, the use of special tools, and tactics of patient management. Conclusion. The prevention of complications, treatment outcomes, and the quality of life of patients receiving interventional antegrade endobiliary surgery are inextricably associated with the technical aspects of interventions, the tools and tool materials, necessary correction of endogenous toxicosis, pancreatitis, hepatic failure, and hemostatic system disorders. Constant monitoring of the results of new technologies is necessary to analyze gathered experience for possible correction and optimization of tactical approaches and schemes for more effective treatment of patients with this severe pathology.