Stage surgical tactics in patients with obstructive jaundice complicated of the acute cholangitis and biliary sepsis

Abstract

Purpose of the study. Improve treatment results of the patients with obstructive jaundice complicated of the acute cholangitis and biliary sepsis.Materials and methods. We analyzed the outcomes of surgical treatment of 200 patients with obstructive jaundice of the non-tumor genesis. The acute cholangitis was observed in 35 patients, which was caused of the biliary sepsis in 10 cases. The patients were divided into three groups: group I (n = 95), where endoscopic methods of biliary decompression were used; group II (n = 48), where biliodigestive anastomoses were formed; and group III (n = 57), where the external drainage of bile ducts was conducted.Results. The patients of the group I demonstrated a gradual decrease of bilirubin and alkaline phosphatase levels, which reached the normal readings on Day 7. The patients of the group II demonstrated normal levels of bilirubin and alkaline phosphataseon Day 14. The patients of the group III demonstrated rapid decrease of bilirubin and alkaline phosphatase levels, which reached the normal readings on Day 28. The transaminase level in each group of patients had reached the norm earlier.Conclusions. Priority is given to stage surgical tactics in patients with obstructive jaundice complicated of the acute cholangitis and biliary sepsis. Single-stage correction is recommended for patients with hyperbilirubinemia of less than 200 mcmol/l and duration of jaundice for less than 14 days, in the presence of compensated or subcompensated co-occurring pathology as well as in the absence of acute cholangitis.Keywords:obstructive jaundice, acute cholangitis, biliary sepsis, biliary decompression.