DAMAGE TO THE EXTRAHEPATIC DUCTS. A MODERN VIEW OF THE PROBLEM
DOI:
https://doi.org/10.11603/2414-4533.2024.4.15064Keywords:
biliary trauma, hepaticojejunostomy, vasculobiliary traumaAbstract
The aim of the work: to study of the causes, risks, prevention and treatment of injuries of the extrahepatic bile ducts, in particular during cholecystectomy, as well as analysis of modern methods of intraoperative diagnostics and restoration of the integrity of the biliary tree.
Materials and Methods. A literature analysis of data on the frequency of biliary injuries, modern methods of surgical interventions (classical and minimally invasive), methods of intraoperative visualization (cholangiography, fluorescent visualization) and methods of reconstruction (hepaticojejunostomy) was used.
Results. Biliary injuries are serious complications that often occur during laparoscopic cholecystectomy. This is due to the peculiarities of the technique and the difficulty of identifying anatomical structures in the hepatoduodenal zone. The analysis conducted indicates the effectiveness of the use of intraoperative visualization methods, such as cholangiography, which can help reduce the risk of bile duct injury by improving visualization of the anatomy. For the treatment of minor injuries, special attention is paid to endoscopic retrograde cholangiopancreatography (ERCP), which is a diagnostic and therapeutic method. It allows to ensure the outflow of bile, eliminate small defects and reduce postoperative complications. At the same time, the experience of the surgeon plays a key role in reducing the frequency of biliary injuries, as confirmed by the learning curve: the risk is significantly reduced after the first 100–200 operations performed. Standardization of the approach to diagnosis and treatment is ensured by the use of classifications such as Bismuth and Strasberg, which systematize the types of injuries depending on their anatomical localization and degree of damage. This allows doctors to make optimal clinical decisions faster and reduce the frequency of complications.
Conclusions. Biliary injury is a serious problem with high risks for the patient. Modern methods of intraoperative imaging are important for minimizing injuries. Patients with serious injuries should be referred to specialized centers. Minimally invasive treatment techniques are a priority.
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