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Year 2017 Vol. 25 No 5

GENERAL & SPECIAL SURGERY

À.V. VARABEI 1, Y.N. ARLOUSKI 1, N.A. LAGODICH 2, V.F. AREHAY 3

X-RAY ENDOBILIARY AND ENDOSCOPIC INTERVENTIONS IN COMPLEX TREATMENT OF INTRAHEPATIC CHOLANGIOLITHIASIS IN HEPATICOJEJUNOSTOMY STRICTURES

SBE “Belarusian Medical Academy of Postgraduate Education” 1,
ME “Minsk Regional Clinical Hospital 2,
SE “Republican Scientific and Practical Center of Oncology and Medical
Radiology named after N.N. Alexandrov” 3, Minsk
The Republic of Belarus

Objectives. To improve the treatment results of patients with the intrahepatic cholangiolithiasis in hepaticojejunostomy strictures using minimally invasive methods.
Methods. During the period from 2009 till 2016 25 patients with hepaticojejunostomy strictures were being treated in our center. 6 of these patients had coexistent intrahepatic cholangiolithiasis. The final diagnosis of hepaticojejunostomy stricture and cholangiolithiasis above the anastomosis was established according to MRI-cholangiography, double balloon enteroscopy and percutaneous transhepatic cholangiography. Rehepaticojejunostomy was performed in 13 (52%) patients. 12 (48%) patients were subject to minimally invasive intervention such as laser vaporization of anastomosis using double balloon enteroscopy (7 patients) and lithoextraction with double balloon enteroscopy (1), transhepatic cholangioscopy (2 patients) with laser lithotripsy (1), balloon dilatation of the stricture of rehepaticojejunoanastomosis (4), lithoextraction (4), including with double balloon enteroscopy («randezvous» procedure) (1), stenting (2). Combined minimally invasive procedures was reduced to performing simultaneous variants of percutaneous transhepatic endobiliary interventions (balloon dilatation, laser vaporization of bile duct concrements through the cholangioscope, stenting of the lobar ducts and the hepaticojejunoanastomoses zone) and endoscopic interventions using a double balloon enteroscope (lithoextraction, sanation).
Results. There were no lethal outcomes after minimally invasive interventions. Among early complications were the following: cholangitis aggravation (5 patients); incrustation of stents with bile concrements - in 1 patient (within 1 year after the procedure), requiring a reoperation; recurrences of HJA strictures (2), for the elimination of which in the period from 6 months till 2 years rehepaticojejunostomy was performed. In the long-term period, in 5 (10.9%) of the operated patients in the period from 6 months up to 3 years the recurrence of HJA stricture was observed. All these patients were subject to rehepaticojejunostomy.
Conclusions. Combined endoscopic and endobiliary techniques of treatment and endobiliary minimally invasive correction of rehepaticojejunostomy strictures and cholangiolithiasis demonstrate good immediate and long-term results.

Keywords: bile ducts, stricture, hepaticojejunostomy, cholangiolithiasis, antegrade interventions, double balloon enteroscopy, lithotripsy
p. 467-475 of the original issue
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Address for correspondence:
223041, Republic of Belarus,
Minsk region, Lesnoy, 1,
ME «Minsk Regional Clinical Hospital»,
Tel.: 375 17 265-22-13,
e-mail: varabeiproct@tut.by,
Alexander V. Varabei
Information about the authors:
Varabei A.V., Corresponding Member of the National Academy of Sciences of Belarus, MD, Professor, Head of the Surgery Department of SBE “Belarusian Medical Academy of Postgraduate Education”.
Arlouski Y.N., PhD, Associate Professor of the Surgery Department of SBE “Belarusian Medical Academy of Postgraduate Education”.
Lagodich N.A., Endoscopist of the Endoscopy Unit of ME “Minsk Regional Clinical Hospital”2.
Arehay V.F., X-ray-Endovascular Surgeon of SE ““Republican Scientific and Practical Center of Oncology and Medical Radiology named after N.N. Alexandrov”.
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