摘要
BACKGROUND It is well known that in case of high initial strictures of bile ducts surgical treatment is associated with a high risk of damage to the hepatoduodenal ligament elements,often involved in rough scarring,and with a significant risk of stricture recurrence.AIM To compare the long-term outcomes of different surgical treatment options for patients with high-grade benign biliary strictures.METHODS From 2012 to 2022,193 patients were treated at the A.V.Vishnevsky Surgical Center.All of them had different levels of strictures according to Bismuth-Strasberg classification:Type E1-2 in 32 patients,type E3-99,type E4-62.123 patients underwent open reconstructive interventions,70 percutaneous endobiliary interventions.RESULTS Long-term results were available for 192(99%)patients with a follow-up of 4.7±1.6 years after reconstructive surgery;3.0±1.4 years after percutaneous interventions.Excellent and good results(according to Terblanche classification)were achieved in 35%(42/122)of patients after open reconstructive surgery and in 13%(9/70)of patients after percutaneous transhepatic interventions(P-value<0.05).CONCLUSION Technically,the most difficult bile duct strictures for reconstructive and percutaneous transhepatic interventions with a high recurrence rate are Bismuth-Strasberg type E4 and E5.The comparative analysis of long-term results of percutaneous and open procedures showed a statistically significant advantage of percutaneous procedures compared to open reconstructive procedures.
