The patients with postoperative biliary strictures: evaluation of the surgical management and remote outcomes

Abstract

Objectives. Surgical management of patients with benign biliary strictures and biliary lesions is a current issue for discussion and raises many scientific research directions. The purpose of this study was to systematize our experience in the treatment of benign biliary strictures, analyzing both immediate and remote complex results. Material and methods. Between 1989-2015 years, there were 203 hospitalized patients with benign biliary strictures in Surgery Department no. 2 of Public Institution, State Medical and Pharmaceutical University (PI SMPhU) “Nicolae Testemitanu”. The study is conducted as part of postdoctoral research; thesis/ dissertation title is Clinical-functional efficiency of modern surgical treatment of benig biliary strictures according to immediate and remote clinical results and was approved by the Science Council of PI SMPhU “Nicolae Testemiţanu” and Ethical Committee (EC) of Ministry of Health (MoH). Clinical evaluation included several consecutive steps: 1) setting the etiopathogenic diagnosis; 2) pre-operatory decompression of the biliary tree; 3) reconstructive surgical act. In the case of biliary strictures, after the initial assessment, bilio digestive derivations were performed according to the level of the obstacle, preferring the bilio-jejunal on isolated loop en Y a la Roux. Conclusions. The iatrogenic stricture of bile duct has a complicated evolution, with many surgeries, requiring many hospitalizations. It should be endeavored to detect them in a timely manner and to prevent septic complications. In the first phase biliary tree decompression will be used, and after decreasing the inflammatory process biliary-digestive reconstruction will be performed. These patients require a complex remote monitoring and analysis of health status.