Causes, diagnosis, and treatment of postoperative obstructive jaundice

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Abstract

AIM: This study aimed to analyze the causes, diagnosis, and clinical treatment of postoperative obstructive jaundice (POOJ) in routine surgical practice.

MATERIALS AND METHODS: Twenty-four patients with POOJ that developed in the organs of the hepatobiliary system after surgical interventions were included in this study. The patients were subjected to the following procedures to diagnose the causes of POOJ and choose the treatment methods: general clinical examination, biochemical blood tests, dynamic postoperative ultrasound examination of the abdominal organs, video laparoscopy, computed tomography, magnetic resonance imaging, fistulocholangiography, endoscopic retrograde cholagiopancreatography, and percutaneous transhepatic cholangiostomy.

RESULTS: POOJ occurred in 18 cases after they had different variants of surgical interventions on the biliary tract after traditional (n = 6) and video laparoscopic cholecystectomy (n = 12). POOJ also developed in 6 cases after they underwent surgery on the liver: atypical (n = 2) and anatomical (n = 2) resection of the liver. This condition manifested after the opening and draining of liver abscesses under US control (n = 2). POOJ was treated with different methods to alleviate the developed complications. After surgical interventions on the liver and biliary tract in 6 cases, relaparotomy, sequestrectomy with sanation, drainage of the abdominal cavity (n = 4), and right-sided hemihepatectomy (n = 2) were performed. In 6 other cases, on days 3–4 of the development of POOJ after laparoscopic operation (n = 2), relaparotomy was performed, clips and ligature were removed from the choledoch with the formation of Roux-en-Y hepaticojejunostomy. Minimally invasive methods of POOJ correction were applied to 12 cases. Of the 12 cases, 5, 2, and 1 were subjected to endoscopic papillosphincterotomy with lithoextraction, endoscopic papillosphincterotomy with lithoextraction coupled with nasobiliary drainage, and relaparoscopy and redrainage of the common bile duct, respectively. In 4 cases, percutaneous transhepatic cholangiostomy was performed at the first stage. At the second stage, after POOJ resolution, the following procedures were implemented: redrainage of the common bile duct (n = 2) and dilatation of the orifice of the right hepatic duct with reconstruction of hepaticojejunostomy on the hidden transhepatic drainage.

CONCLUSION: POOJ is still encountered in clinical practice in a sufficient number of cases. Treatment results largely depend on the time of diagnosis and the choice of optimal surgical strategies. The main causes of POOJ are tactical and technical diagnostic and treatment errors. POOJ is diagnosed on the basis of the data of modern radiation and laboratory and instrumental examination methods. Surgical tactics for POOJ are individually active and dependent on the severity, time, and causes of development. They also depend on the general condition of patients. Along with minimally invasive interventions for POOJ, early relaparotomy is less dangerous than passive expectation tactics.

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About the authors

Makhmadsho K. Gulov

Ibn Sina Tadjik State Medical University

Email: egan0428@mail.ru
ORCID iD: 0000-0001-5151-937X
SPIN-code: 5463-6781

MD, Dr.Sci.(Med.), Professor of the General Surgery Department №1

Tajikistan, Dushanbe

Kakhramon R. Ruziboyzoda

Ibn Sina Tadjik State Medical University

Author for correspondence.
Email: dr.hero85@mail.ru
ORCID iD: 0000-0001-8381-0364

MD, Cand.Sci.(Med.), Assistant of the Surgical Diseases Department №1

Tajikistan, Dushanbe

References

  1. Barykov VN, Abaidulin RZ, Halilov EM, et al. Structure, causes and prevention of complications of percutaneous transhepatic cholangiostomy in obstructive jaundice. Yuzhno-Ural’skiy Meditsinskiy Zhurnal. 2018;(2):15-8. (In Russ).
  2. Kurbonov KM, Nazirboev KR. Methods of minimally invasive decompression of the biliary tract with mechanical jaundice. Bulletin of Surgery. 2018;177(1):74-7. (In Russ). doi: 10.24884/0042-4625-2018-177-1-74-77
  3. Nakaoka K, Hashimoto S, Kawabe N, et al. Evaluation of a 12-mm diameter covered self-expandable end bare metal stent for malignant biliary obstruction. Endoscopy International Open. 2018;6(10):E1164-70. doi: 10.1055/a-06277078
  4. Malkov IS, Shaimardanov RSh, Korobkov VN, et al. The factors affecting the results of mechanical jaundice management. Khirurgiya. 2016;(10):48-51. (In Russ). doi: 10.17116/hirurgia20161048-51
  5. Porkhanov VA, Zavrazhnov AA, Bykov MI, et al. Oslozhneniya endoskopicheskikh metodov dekompressii zhelchevyvodyashchikh protokov pri sindrome mekhanicheskoy zheltukhi. Al’manakh Instituta khirurgii im. A.V. Vishnevskogo. 2015;10(2):1613. (In Russ).
  6. Nazirboev KR, Kurbonov KM. Ways to improve results of surgical treatment of mechanical yellow of beneficial genesis. Bulletin of Pirogov National Medical and Surgical Center. 2017;12(4,pt2):52-5. (In Russ).
  7. Shao J-H, Fang H-X, Li G-W, et al. Percutaneous transhepatic biliary drainage and stenting for malignant obstructive jaundice: A report of two cases. Experimental and Therapeutic Medicine. 2015;10(4):1503-06. doi: 10.3892/etm.2015.2701
  8. Xu C, Lv P-H, Huang X-E, et al. Internal-external percutaneous transhepatic biliary drainage for patients with malignant obstructive jaundice. Asian Pacific Journal of Cancer Prevention. 2014;15(21):9391-4. doi: 10.7314/apjcp.2014.15.21.9391
  9. Yu H, Wu S, Yu X, et al. Single-incision laparoscopic biliary bypass for malignant obstructive jaundice. Journal of Gastrointestinal Surgery. 2015;19(6):1132-8. doi: 10.1007/s11605-015-2777-4
  10. Voronova EA, Pakhomova RA. Modern concepts of classification obstructive jaundice. Modern Problems of Science and Education. 2015;(6):298. Available at: https://science-education.ru/ru/article/view?id = 23902. Accessed: 2021 February 02. (In Russ).
  11. Galperin EI, Chevokin AIu. Intraoperative injuries of bile ducts. Khirurgiya. 2010;(10):4-10. (In Russ).
  12. Kijirov JN, Malakhova JI, Sayutin VE, et al. MRCP vs. ERCP in diagnosing the obstructive jaundice. Vestnik KazNMU. 2015;(1):242-8. (In Russ).
  13. Lomakin IA, Ivanov YuV, Sazonov DV, et al. Methods of diagnostics and treatment of patients with mechanical jaundice. Klinicheskaya Praktika. 2012;(3):42-50. (In Russ).

Supplementary files

Supplementary Files
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1. Fig. 1. Ultrasound scan of the liver of patients with Postoperative Obstructive Jaundice: A – dilation of the intrahepatic bile ducts after ligation; B – dilation of the intrahepatic bile ducts, choledocholithiasis.

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2. Fig. 2. Magnetic resonance cholangiopancreatography : complete occlusion of choledoch.

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3. Fig. 3. Abscess of the right lobe of the liver.

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4. Fig. 4. Condition after right-sided hemihepatectomy

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5. Fig. 5. Stages of intervention in a patient with developed permanent residence: A – clipping of common bile duct, B – formed hepaticojejunostomy.

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Copyright (c) 2021 Ruziboyzoda K., Gulov M.



Свидетельство о регистрации СМИ ПИ № ФС77-76803 от 24 сентября 2019 года выдано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).


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