Amro A. Estimation of various kinds of the biliary drainage operations in high biliary ducts cicatricial strictures

Dissertation is devoted to the problems solving concerning improvement of the treatment results of high biliary ducts cicatricial stricture. The work is based on the data of the complex examination estimation in 90 patients with high biliary ducts cicatricial stricture using clinico-laboratory and instrumental methods. The classification of high cicatricial stricture is improved, the two-staged rational algorithm-scheme of preoperative diagnosis using predominantly noninvasive methods, at the first stage, and of the direct biliary ways contrasting, at the second stage, is elaborated. The efficacy of various methods restoration of the main biliary ducts outflow after the cicatricial stricture excision was estimated. It is established that the principal operations one expedient to apply in partial cicatricial affection of the ducts walls. While the circular defect present due to the duct trauma and the cicatricially-changed tissues excision, high hepaticojejunostomy is the operation of choice. This inter vention includes the longitudinal incision of anterior wall of left hepatic duct and the anastomosis formation with left and right ducts separately or together with jejunal loop in Rouxen-Y fashion and the excluded segment no less than 60 cm long for the regurgitational cholangitis prophylaxis.