Anatomical characteristics and clinical rationale of endobiliary surgeries for benign obstructional jaundice

Variants of the anatomical structure of the bile ducts were studied based on endobiliary cholangiography performed in 150 patients who were treated in surgical clinics with a diagnosis of obstructive jaundice of non-tumor etiology, and a retrospective and prospective analysis of the results of their treatment was carried out. The study included the sequence of treatment and diagnostic techniques, the content of preoperative preparation and the alternation of various minimally invasive endobiliary operations. The patients were divided into control and main groups. The control group consisted of 30 patients who were operated on immediately after short-term preoperative preparation; they underwent cholecystectomy, choledocholithotomy with external drainage of the common bile duct. The main group included 120 patients who, along with special preoperative preparation, underwent two- or three-stage surgical interventions on the biliary tract. Various variants of the structure of both extrahepatic and intrahepatic bile ducts were identified, which were taken into account during the surgery and the formation of endobiliary approaches. Decompression of the biliary tract was carried out on the second or third day against the background of active infusion therapy, which continued in the postoperative period. The use of the method of percutaneous transhepatic decompression of the biliary tract using external-internal drainage is possible for any type of bile duct structure. This technique allows to reduce the percentage of postoperative complications from 46% to 23% and reduces the number of deaths from 34% to 11.7%. The use of preoperative preparation and endobiliary drainage methods stabilizes the condition of patients in the preoperative period, relieves the phenomena of cholestasis and cholangitis and allows surgical intervention to be performed under more favorable conditions.