Correction of Biliary Hypertension in the Treatment of Patients With Mechanical Jaundice

Summary. Among the surgical diseases of the liver and extrahepatic biliary tract, the most severe patients are those with mechanical jaundice syndrome. The main task of surgical intervention in mechanical jaundice is to decompress the biliary tract, eliminate obstruction, eliminate jaundice and prevent the onset or progression of liver failure. Materials and methods. The results of examination and treatment of 389 patients with mechanical jaundice of various genesis are presented. The diagnostic program included conventional laboratory tests, ultrasound, computed tomography, endoscopic retrograde pancreatic cholangiography, percutaneous transhepatic cholangiography. The results. Conservative therapy, preliminary decompression of the bile ducts and surgery were performed in patients with mechanical jaundice. Conservative therapy allowed to reduce the manifestations of mechanical jaundice in 78 (20 %) patients. Emergency surgery was performed in 213 patients (68.5 %). Urgent surgeries were performed in 98 (31.5 %) patients if instrumental decompression of the bile ducts was not possible. Postoperative mortality was 10.6 % (33 patients out of 311 operated patients). Conclusions. The choice of drainage method should be based on the localization of the process, topographic and anatomical features of the biliary system. In the case of gallbladder tumors or extrahepatic bile ducts, the method control of ultrasound or radiological examination. Endoscopic methods are indicated in case of pathology of the pancreatic head and large duodenal papilla. Cholecystostomy or cholangiostomy are applicable in the same situations when endoscopic drainage is technically impossible.