Causes, diagnosis, and treatment of postoperative obstructive jaundice

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.

Keywords

cholecystectomy / liver resection / technical and tactical errors / postoperative obstructive jaundice / relaparotomy / relaparoscopy / minimally invasive interventions

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] Барыков В.Н., Абайдулин Р.Ж., Халилов Э.М., и др. Структура, причины и профилактика осложнений чрескожной чреспеченочной холангиостомии при механической желтухе // Южно-Уральский медицинский журнал. 2018. № 2. С. 15-18.

[3] 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

[4] Курбонов К.М., Назирбоев К.Р. Методы миниинвазивной декомпрессии желчных путей при механической желтухе // Вестник хирургии им. И.И. Грекова. 2018. Т. 177, № 1. С. 74-77. doi: 10.24884/0042-4625-2018-177-1-74-77

[5] 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

[6] 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.Vol. 6, № 10. Р. E1164-E1170. doi: 10.1055/a-0627-7078

[7] 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

[8] Малков И.С., Шаймарданов Р.Ш., Коробков В.Н., и др. Факторы, влияющие на результаты лечения больных с механической желтухой // Хирургия. Журнал им. Н.И. Пирогова. 2016. № 10. С. 48-51. doi: 10.17116/hirurgia20161048-51

[9] 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).

[10] Порханов В.А., Завражнов А.А., Быков М.И., и др. Осложнения эндоскопических методов декомпрессии желчевыводящих протоков при синдроме механической желтухи // Альманах Института хирургии им. А.В. Вишневского. 2015. Т. 10, № 2. С. 1613.

[11] 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).

[12] Назирбоев К.Р., Курбонов К.М. Пути улучшения результатов хирургического лечения механической желтухи доброкачественного генеза // Вестник Национального медико-хирургического центра им. Н.И. Пирогова. 2017. Т. 12, № 4, ч. 2. С. 52-55.

[13] 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

[14] 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. Vol. 10, № 4. Р. 1503-1506. doi: 10.3892/etm.2015.2701

[15] 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

[16] 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. Vol. 15, № 21. Р. 9391-9394. doi: 10.7314/apjcp.2014.15.21.9391

[17] 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

[18] Yu H., Wu S., Yu X., et al. Single-incision laparoscopic biliary bypass for malignant obstructive jaundice // Journal of Gastrointestinal Surgery. 2015. Vol. 19, № 6. Р. 1132-1138. doi: 10.1007/s11605-015-2777-4

[19] 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).

[20] Воронова Е.А., Пахомова Р.А. Современные представления о классификации механической желтухи // Современные проблемы науки и образования. 2015. № 6. С. 298. Доступно по: https://science-education.ru/ru/article/view?id=23902. Ссылка активна на 02 февраля 2021.

[21] Galperin EI, Chevokin AIu. Intraoperative injuries of bile ducts. Khirurgiya. 2010;(10):4-10. (In Russ).

[22] Гальперин Э.И., Чевокин А.Ю. «Свежие» повреждения желчных протоков // Хирургия. Журнал им. Н.И. Пирогов. 2010. № 10. С. 4-10.

[23] Kijirov JN, Malakhova JI, Sayutin VE, et al. MRCP vs. ERCP in diagnosing the obstructive jaundice. Vestnik KazNMU. 2015;(1):242-8. (In Russ).

[24] Кыжыров Ж.Н., Малахова Ю.И., Саютин В.Е., и др. Сравнение МРХПГ и ЭРХПГ в диагностике механической желтухи // Вестник Казахского Национального медицинского университета. 2015. № 1. С. 242-248.

[25] 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).

[26] Ломакин И.А., Иванов Ю.В., Сазонов Д.В., и др. Диагностика и лечебная тактика у больных с механической желтухой // Клиническая практика. 2012. № 3. 42-50.

RIGHTS & PERMISSIONS

Ruziboyzoda K., Gulov M.