INDICATIONS FOR BILIARY DECOMPRESSION AND CHOICE OF BILIODIGESTIVE ANASTOMOSIS IN PANCREATICODUODENAL RESECTION

Abstract

Summary. Objective. To develop an algorithm for choosing the method of biliary decompression and to determine the optimal method of biliodigestive anastomosis in pancreaticoduodenal resection (PDR). Materials and methods. Pancreaticoduodenal resection was performed in 302 patients with obstructive diseases of the pancreaticoduodenal zone. Biliary decompression was performed in 62 (20,5 %) patients, the following methods were used: percutaneous perhepatic cholangiodrainage, endoscopic stenting, various variants of cholecystostomy, biliodigestive anastomosis. At the reconstructive stage of PDR biliodigestive anastomoses were performed: hepaticojejunoanastomosis, choledochojejunoanastomosis, cholecystojejunoanastomosis. Results and discussion. Percutaneous perhepatic cholangiodrainage was performed in 22 (35.5 %) patients, endoscopic stenting – in 21 (34.4 %), cholecystostomy – in 9 (14.5 %), biliodigestive anastomo-sis – in 10 (16.1 %). At the reconstructive stage of pancreaticoduodenal resection, a biliodigestive anastomosis on a single loop of jejunum (along with pancreaticjejunoanastomosis and gastroenteroanastomosis) was performed in 282 (93,4 %) patients, on a separate loop – in 10 (6,8 %) patients, reconstruction of the biliodigestive anastomosis – in 4 (1,3 %) patients, in 6 (2,0 %) patients the biliodigestive anastomosis was preserved for the purpose of biliary decompression at the first stage of treatment. Conclusions. Among the methods of biliary decompression, the use of percutaneous coronary intervention and endoscopic stenting is preferable, which allows performing pancreaticoduodenal resection with minimal perioperative complications; in the choice of biliodigestive anastomosis for pancreaticoduodenal resection the optimal is the performance of hepaticojejunoanastomosis.