Novosti
Khirurgii

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Year 2022 Vol. 30 No 2

CASE REPORTS

À.V. VARABEI 1, V.F. OREKHOV 2, N.À. LAGODICH 1, À.S. KAPRAN 1, Å.I. VIZHINIS 1

MINIMALLY INVASIVE METHOD OF TREATMENT OF SCAR STRICTURE OF HEPATICO-JEJUNAL ANASTOMOSIS

Belarusian Medical Academy of Postgraduate Education 1,
N.N.Alexandrov National Cancer Centre of Belarus 2, Minsk,
The Republic of Belarus

Strictures of hepatico-jejunal anastomosis (HJA) are a topical problem in the biliary surgery. This pathology is often complicated by recurrent cholangitis, cholangiolithiasis, liver failure and cirrhosis. This observation presents a clinical case of minimally invasive treatment of a 56-year-old patient with cicatricial stricture of hepatico-jejunal-anastomosis, recurrent cholangitis, cholangiolithiasis. The patient underwent gastropancreatoduodenal resection with resection of paranephric tissue and mesocolon for locally distributed stenosing duodenal cancer (T4N0M0-moderately differentiated adenocarcinoma with an average degree of differentiation). In connection with the developed cicatricial stricture of HJA, an attempt to perform the antegrade Rendezvous technique: double-balloon endoscopy has been made. The latter attempt due to the adhesion process around the Roux loop was failed. The percutaneous transhepatic cholangiostomy (PTC) was performed through the left lobe of the liver under US and X-rays control, HJA recanalization, balloon dilatation of the HJA stricture, external – internal bile drainage. Subsequently, second endoscopic balloon dilatation of the HJA stenosis was performed. More later repeated balloon dilation of HJA, mechanical lithotripsy, and lithoextraction were carried out. Cholangiography revealed a rigid HJA stricture. Biliary stenting was performed with a self-expanding nitinol stent «SX-Ella» with a diameter of 8 mm and a length of 40 mm for internal bile drainage. At the control examination after 10 months no complaints were recorded.

Keywords: hepatico-jejunal-anastomosis, stricture, cholangiolithiasis, cholangitis, percutaneous - transhepatic interventions, balloon dilatation, Dormia basket, lithotripsy, lithoextraction, stenting, choledochoscopy
p. 214-220 of the original issue
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Address for correspondence:
223041, Republic of Belarus,
Minsk Region, Lesnoy, 1,
Minsk Regional Clinical Hospital,
Surgical Unit,
tel. office: +375172652213,
e-mail: dept-surg@hotmail.com,
Varabei Aliaksandr V.
Information about the authors:
Varabei Aliaksandr V., Corresponding Member of the National Academy of Sciences of Belarus, MD, Professor, Head of the Surgery Department of Belarusian Medical Academy of Postgraduate Education, Minsk, Republic of Belarus.
https://orcid.org/0000-0002-9765-2755
Orekhov Vitali F., X-Ray-Endovascular Surgeon, N.N.Alexandrov National Cancer Centre of Belarus, Minsk, Republic of Belarus.
https://orcid.org/ 0000-0002-6056-855X
Lahodzich Natallia A., PhD, Associate Professor of the Surgery Department, Belarusian Medical Academy of Postgraduate Education, Minsk, Republic of Belarus.
https://orcid.org/0000-0001-9870-7204
Kapran Aliaksandr S., Post-Graduate Student, the Surgery Department, Belarusian Medical Academy of Postgraduate Education, Minsk, Republic of Belarus.
https://orcid.org/0000-0002-7570-0509
Vizhinis Ezhi I., PhD, Associate Professor, the Surgery Department, Belarusian Medical Academy of Postgraduate Education, Minsk, Republic of Belarus.
http://orcid.org/0000-0002-9185-7119
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