Choice of surgical tactic for high cicatricial strictures of bile ducts

In this scientific work the results of surgical treatment of patients with high scar strictures of bile ducts leading to complications of different nature and frequency are analysed. Presence of established formidable and severe complications dictate the necessity of dynamic observation and examination and timely operative treatment. Each particular patient has an individual approach to surgical intervention. The aim of the work is to improve the results of surgical treatment of patients with high scar strictures of bile ducts by choosing the optimal surgical tactics. The aim of the work is to improve the results of surgical treatment of patients with high scar strictures of bile ducts by choosing the optimal surgical tactics. Percutaneous transhepatic cholangiography, fistulography, CT and MRI were used in diagnostics. There were 35 patients with high strictures of bile ducts under observation, 11 of them with recurrence of strictures of the previously applied biliradigestive anastomosis (BDA). 34 patients were operated, reconstructive operations were performed in 29 patients. Specific complications after reconstruction occurred in 28.6% of cases, the use of transhepatic drainage (TPD) as a forced measure was in 62.8% of patients. The final stage of the operation, both for primary and for subsequent corrections of bile ducts lesions and strictures, is BDA on the disconnected loop according to Roux, with observance of precision technique and restriction of TPD application, it allows to achieve good long-term results. 34 patients were operated, in one case there was a lethal outcome at the stage of preoperative preparation due to the development of hepatic insufficiency. Reconstructions were performed in 29 (82,8%) patients, where it was possible to restore bile flow by hepatico(cholangio)eunoanastomosis with the loop of jejunum disconnected by Roux at least 60 cm, such tactics was used as the main or final stage of the operation. At BDA formation we attached importance to the precision tissue matching with the use of atraumatic absorbable suture material, without scar changes and without tissue tension. The choice of tactics at primary correction of bile ducts injuries is recommended depending on the level of GEA duct damage (choledocho-, cholangio-) by the Roux loop disconnected and maximum restriction of TPD use, as other variants of BDA previously considered optimal in such situation have unsatisfactory results in the remote period.