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2Impact Factor: SJIF 2021 - 5.S1 2022 - 5.94
МЕДИЦИНСКИЕ НАУКИ MEDICAL SCIENCES
UDC: 616.37-001.366-089 MODERN ViERWS ON THE CAUSES OF DiAGNOSiS AND TREATMENT AND iATROGENiC DAMAGE TO THE BiLE DUCTS, COMPLiCATED BY BiLE LEAKAGE
doctor of medical sciences, professor, liver, biliary tract, head of the pancreas department of Scientific Center of Surgery after academician M.A.Topchubashov
ALiEVA ELMiRA AGAALi
doctor of medicine, senior researcher of liver, bile ducts, pancreas department of Scientific Center of Surgery after academician M.A.Topchubashov
SHiRiNOV ZERRAF TAHMAZ
doctor of medical sciences, professor, senior researcher of the liver, bile ducts, pancreas department of Scientific Center of Surgery after academician M.A.Topchubashov
IDRiSOV FARAJ SADULLA
PhD of medical sciences, senior researcher of liver, biliary tract, pancreas department
EMiNOV RAFAEL ZiYAT
junior researcher of liver, biliary tract, pancreas department of Scientific Center of Surgery after academician M.A.Topchubashov
Summary: The purpose of the work was to evaluate the effectiveness of endoscopic, percutaneous treatment methods with minimal access for bile leakage with the formation of a bilome. 37patients with iatrogenic damage to the biliary tract (IBD), complicated by bile leakage during cholecystectomy, were analysedfor the period 2019-2023. 26 (70.2%) cases of PTLD were observed with laparoscopic, and 11 (29.7%) with traditional cholecystectomy. Of the 37 patients, 25 (67.5%) were admitted from other institutions in district hospitals, 11 (29.7%) patients were operated on in our clinic. In the analysed group there were 27 women (72.9%) and 10 men (2.7%). The introduction of minimally invasive technologies into surgical practice fo iatrogenic damage to the biliav tract, regardless of the method of treatment, accompanying bile leakage allows for the provision of surgical care without major interveations, taking into accont compliance with the range of performance and certain indications and contraind-ications.
Key words: iatrogenic damage, bile ducts, bile leakage, diagnosis, treatment
Despite the widespread use of surgical removal of the gallbladder, performed in various modifications (traditionally and laparoscopically), there is extensive experience with these interventions, the results of this treatment do not satisfy the surgical community due to the relatively high rates of postoperative complications (1,5-3,5%) and mortality (1,1-5,4%).
Among the complications that often occur during cholecystectomy (both traditional and laparoscopic) are iatrogenic damage to the bile ducts (IBD), manifested as bile leakage. We often observe bile leaks in small lesions, which can be detected both during surgery and in the early postoperative period. The formation of an encapsulated accumulation of bile in the extra-biliary tract, in the abdominal cavity these are biomass. The most common localization of the bilome is the subhepatic space, and its source this is iatrogenic damage to the bile ducts (1.5-3.5%). Active development of minimally invasive interventions and a high percentage of their successful use in the treatment of "fresh" injuries of the extrarenal bile ducts, allows them to be used as an independent method of treatment.
Considering the above, this topic remains relevant.
MAMEDOV ALINIYAZ ALI
Impact Factor: SJIF 2021 - 5.81 2022 - 5.94
МЕДИЦИНСКИЕ НАУКИ MEDICAL SCIENCES
The purpose of the work is to evaluate the effectiveness of endoscopic, percutaneous treatment methods with minimal access for bile leakage with the formation of a bilome.
Materials and methods: 37 patients with iatrogenic damage to the biliary tract (IBD), complicated by bile leakage during cholecystectomy, were analysed for the period 2019-2023.
26 (70.2%) cases of PTLD were observed with laparoscopic, and 11 (29.7%) with traditional cholecystectomy. Of the 37 patients, 25 (67.5%) were admitted from other institutions in district hospitals, 11 (29.7%) patients were operated on in our clinic. In the analysed group there were 27 women (72.9%) and 10 men (2.7%).
The average age ranged from 29-69 years. Features of the detected observations were: Mirizzi syndrome 9 (24.32%), wrinkled gallbladder in a dense infiltrate 11 (29.7%), anatomical variants of the bile ducts 3 (8.1%), choledocholithiasis 10 (27.0%), peripancreatic infiltrate 4 (10.8%), early 20 (54.0%), late 14 (37.8%).
Detection of bile leakage intraoperatively, 3 (8.1%), choledocholithiasis in 10 (27.0%), late 14 (37.8%), hospital
Bile leakage through safety drains with the development of bilome in 26 (70.2%), free abdominal cavity with the development of peritonitis in 2 (5.4%) patients. These patients were admitted from regional hospitals.
Depending on the location and nature, damage to the incompetent stump of the cystic duct 9 (24.3%), damage to Luschka's passages 20 (54.0%), marginal damage to the gallbladder 4 (10.8%), complete intersection of the gallbladder 2 (5.4%) damage to the right hepatic duct by choledocholithiasis 2 (5.4%).
Treatment: If the stump of the cystic duct (CD) fails, retrogranic stenting of the CBD was performed with the addition of drainage according to Cholsted
In case of bile leakage through the safety drainage in belomas, depending on the location and size, the treatment tactics were expectant and conservative treatment. In large biomes, if the bile leakage did not decrease, then percutaneous drainage was performed under X-ray control. With incessant bile duct and no decrease in the bile duct due to choledocholithiasis detected during cholangiography, the cause of increased bile duct was hypertension, considering the cause. We performed endoscopic papilosphincterotomy with lithexstraction and septation of the CBD.
All patients achieved recovery.
Conclusions: the introduction of minimally invasive technologies into surgical practice fo iatrogenic damage to the biliav tract, regardless of the method of treatment, accompanying bile leakage allows for the provision of surgical care without major interveations, taking into accont compliance with the range of performance and certain indications and contraind-ications.
For small subhepatic bilomes a wait-and-see approach is resorption. But for large bilomes, the cause of obstructed bile flow and its elimination, minimally invasive surgical treatment gevis a remarkable result.
REFERENCES
1. Pesce A., Palmucci S., La Greca G. et al. Iatrogenic bile duct injury: impact and management challenges // Clin Exp Gastroenterol., - 2019. -12. - p. 121-128
2. Abdelgawad, M.S., Eid, M., Abokoura, S. et al. Iatrogenic bile duct injuries after laparoscopic cholecystectomy: evaluation by MRCP before management // Egypt Liver Journal, - 2023, - 13 (2)
3. Jablonska B., Lampe P. Iatrogenic bile duct injuries: etiology, diagnosis and management // World J Gastroenterol., - 2009. - 15(33). - p.4097-4104.
