SURGICAL TREATMENT TACTICS FOR PATIENTS WITH MECHANICAL JAUNDICE CAUSED BY STRICTURES OF THE EXTRAHEPATIC BILE DUCTS

Mechanical (obstructive) jaundice secondary to strictures of the extrahepatic bile ducts represents one of the most demanding, time-critical, and potentially life-threatening emergencies encountered in modern hepatobiliary and pancreatic surgery. This condition arises from complete or partial mechanical blockage of bile flow from the liver through the common hepatic duct, common bile duct, and into the duodenum. It rapidly triggers a cascade of severe complications, including ascending cholangitis (Charcot’s triad or Reynolds pentad), life-threatening sepsis, acute kidney injury driven by endotoxemia, coagulopathy secondary to impaired vitamin K absorption, and inexorable progression to irreversible secondary biliary cirrhosis if left untreated. Intraductal pressure exceeding 20 cm H₂O precipitates hepatocyte ballooning, Kupffer-cell activation, bacterial translocation across damaged cholangiocytes, and activation of profibrotic signaling pathways (primarily TGF-/Smad cascades). Extrahepatic obstruction demands immediate diagnostic stratification, biliary decompression, and definitive anatomic reconstruction. This exhaustive 2026 monograph synthesizes the highest-impact evidence from over 40 rigorously selected peer-reviewed sources, including landmark 2025–2026 publications, major international guidelines (ESGE 2025, ASGE 2023, ACG 2023, and SAGES-AHPBA 2025).1 The work delivers a complete, anatomy-driven, evidence-based surgical roadmap that integrates historical evolution, molecular pathophysiology, tiered diagnostics, comprehensive preoperative optimization protocols, exhaustive operative atlases, long-term outcome data, quality-of-life trajectories, economic modeling, and region-specific adaptations for Central Asia. Roux-en-Y hepaticojejunostomy (HJ) with mucosa-to-mucosa, tension-free, high biliary-enteric anastomosis at the Hepp-Couinaud level remains the unequivocal gold standard for benign strictures, delivering 85–95% long-term stricture-free patency. Future horizons, including AI-assisted 3D biliary planning and bio-printed stem-cell-seeded conduits, are poised to redefine the field.5

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