Tactics of management of patients with complications of bile disease, manifested by mechanical jaundice depending on stages of its development

Fedorov V.Je.¹, Haritonov B.S.¹, Aslanov A.D.², Logvina O.E.², Naryzhnaja M.A.¹, Masljakov V.V.³

The work includes 537 patients who were treated between 2010 and 2019 with the diagnosis of bile disease complicated by mechanical jaundice. There were 301 (56,1%) women. Men received less: 236 (43,9%) people. The ratio of women to men in all groups was comparable. The vast majority of the patients were over the age of 60: 207, which was 38,5%. The number of young people under 30 years of age was 43 (8 per cent). Among them were 5 (0,9%) people aged 18 and 19. Over the age of 80, there were 49 (9,1%) people. After decompression of the bile tract 500 (93,1%) of patients, various surgical interventions were performed. Abdominal and retroperitoneal purulent-necrotic complications occur with the same frequency in both groups: 13 cases, amounting to 5,2%, but in the investigated group they concentrated in the group with cholangitis: a quarter of cases. Organ and systemic complications differ by half: after the introduction of personalized tactics, they decreased from 26 (10,4%) cases to 14 (5,6%). The second thing that draws attention to is the “shift” in the number of complications to the group of patients with cholangitis, where the number of purulent local complications after the introduction of the personalized approach decreased from 7 (2,8%) cases of wound nudity to 5 (1,9%) — in the investigated group. In abdominal inflammatory septic processes, the number of complications decreased in persons with postoperative peritonitis from 13 (5,2%) cases to 7 (2,8%), that is, by half. The sick part of such complications in the investigated group — 4 (11,1%) cases, were operated with cholangitis. The third feature of the development of complications is damage and insufficiency on the part of all major organs and systems. In the examined group, the number of cases of such complications even increased from 7 (2,8%) to 14 (5,6%), which is due to organ failure again in patients with cholangitis, the most severe group subjected to surgical treatment.

1. Vinokurov MM, Petrov AP, Petrov MA, Jalynskaja TV. Improving surgical outcomes of elderly and senile patients with acute cholecystitis complicated by mechanical jaundice. Vestnik Severo-Vostochnogo federal’nogo universiteta im. M.K. Ammosova. 2016;3(4):25–29.

2. Hil’ko SS, Vlahov AK, Butyrskij AG, Bobkov OV. Optimization of surgical treatment of patients with mechanical jaundice and liver failure. Tavricheskij mediko-biologicheskij vestnik. 2017;20(1):73–79.

3. Rebrov AA, Semenov DJu, Gunja ZA, et al. Treatment of complications following percutaneous endobiliary interventions in mechanical jaundice. Vestnik hirurgii im. I.I. Grekova. 2018;177(1):69–73.

4. Mihajlichenko VJu, Kisljakov VV, Reznichenko AM, Samarin SA. Current aspects of surgical management of mechanical jaundice syndrome. Current problems of science and education. 2019;3:48–54.

5. Muhiddinov ND, Salihov NN, Rabiev HS, Kurbonov NG. Miniinvasive methods of diagnosis and treatment of bile stone disease complicated by choledocholytiasis and mechanical jaundice. Vestnik Akademii medicinskih nauk Tadzhikistana. 2019;9(3):278–284.

6. Abdurahmanov MM, Obidov UU, Ruziev UU, Muradov TR. Surgical treatment of mechanical jaundice syndrome. Zhurnal teoreticheskoj i klinicheskoj mediciny. 2020;1:59–62.

7. Podoluzhnyj VI. Mechanical jaundice: principles of diagnosis and modern surgical treatment. Fundamental’naja i klinicheskaja medicina. 2018;3(2):82–92.

8. Prazdnikov JeN, Baranov GA, Zinatulin DR, et al. Antegrade access possibilities in the treatment of cholangiolithiasis complicated by mechanical jaundice syndrome. Hirurgija. Zhurnal im. N.I. Pirogova. 2018;(1):21–25. Doi: 10.17116/hirurgia2018121-25.

9. Kolobov SV, Shevchenko VP, Zinatulin DR, et al. Balloon cholangioplasty of cicatricial lesions of the bile ducts and cholangioeural fistula. Hirurg. 2016; 3:19–25.

10. Oh H.C. Percutaneous Transhepatic Cholangioscopy in Bilioenteric Anastomosis Stricture. Clinical Endoscopy. 2016;49(6):530–532. Doi: 10.5946/ce.2016.125.

11. Nazirboev KR, Kurbonov KM. Ways to improve surgical treatment of mechanical jaundice of benign genesis. Vestnik Nacional’nogo mediko-hirurgicheskogo Centra im. N.I. Pirogova. 2017;12(4-2):52–55.

12. Xu Y, Dong C, Ma K, et al. Spontaneously removed biliary stent drainage versus T-tube drainage after laparoscopic common bile duct exploration. Medicine. 2016;95(39):5011. doi: 10.1097/md.0000000000005011.

13. Podoluzhnyj VI. Cholelithiasis complications. Basic and Clinical Medicine. 2017;2(1):102–114.

14. Hassan C, Quintero E, Dumonceau JM, et al. Post-polypectomy colonoscopy surveillance: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2013;45(10):842–851. doi: 10.1055/s-0033-1344548.

15. Rogal’ ML, Novikov SV, Magomedbekov MM, et al. Choice of surgical treatment of patients with acute cholecystitis complicated by choledocholytiasis. Khirurgiya. Zhurnal im. N.I. Pirogova. 2018;4:41–45.

16. Kurbonov KM, Nazirboev KR, Saidov RH, Sultonov BD. Surgical tactics for acute cholecystitis complicated by choledocholetiasis and mechanical jaundice. Vestnik Avitsenny. 2017;19(3):344–348. (In Russ).] doi: 10.25005/2074-0581-2017-19-3-344-348.

17. Palatova LF, Nechaev OI. Evolution of the problem of differential diagnosis of mechanical jaundice in the Western Urals. Experimental and clinical gastroenterology. 2017;142(6):150–154.

18. Hurwitz EE, Simon M, Vinta SR, et al. Adding examples to the ASA-Physical Status classification improves correct assignments to patients. Anesthesiology. 2017;126(4):614–622. doi: 10.1097/ALN.0000000000001541.

19. Mayhew D, Mendonca V, Murthy BV. A review of ASA physical status –historical perspectives and modern developments. Anaesthesia. 2019;74(3):373–379. doi: 10.1111/anae.14569.