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,an...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.展开更多
文摘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.
