Effective approaches to reconstructive surgeries for fresh injuries and scar constrictions of common bile ducts

Background. Treatment of bile duct injury is extremely difficult, requires expensive therapeutic and diagnostic procedures, and leads to serious disability in patients. Mortality is 8–17 %, complications during ope­rations occur in up to 47 % of cases, post-traumatic strictures of the bile ducts — in up to 35–55 %. The purpose of the study: to evaluate the effectiveness of the new technique in preventing hepaticocholedochal stricture in the long-term postoperative period following reconstructive surgery. Materials and methods. This investigation was conducted through clinical assessment of 41 individuals suffering from main bile duct injuries who underwent surgical procedures at the Samarkand State Medical University’s multidisciplinary clinic between 2010 and 2022. The participants were categorized into two distinct groups based on treatment approach. The comparison group included 18 patients (43.9 %) who underwent conventional biliobiliary anastomosis surgery. The main study group consisted of 23 patients (56.1 %) who underwent reconstructive operations utilizing our enhanced surgical technique. Results. Thirteen patients in the comparison group had cicatricial stricture of hepaticocholedoch in the long-term postope­rative period after 1–3 years, which required repeated operations. Of these, 9 people underwent reconstructive surgery of hepaticojejuno- and hepaticoduodenoanastomosis, 4 patients had X-ray endobiliary interventions with the installation of a stent in the lumen of hepaticoholedoch. Conclusions. Thus, the proposed new method of reconstructive surgery that consists in the fact that to form a biliobiliary anastomosis, the edge of the distal end of the hepaticocholedoch is turned from the inside out by 2–3 mm, followed by the imposition of nodular sutures, is a reliable way to minimize cicatricial strictures of the hepaticocholedoch in the long-term postoperative period.

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