Obuobi R. Prophylaxis and treatment of multiorganic failure at surgical correction of mechanical jaundice of non-malignant genesis.

The work is devoted to pathogenesis and features of multiorganic failure in patients with mechanical jaundice of non-malignant origin. The progress of mechanical jaundice after operative procedure on the biliary tract leads to changes not only in the liver, but also in other organs with the development of multiorganic failure (MOF) associated with very high mortality rate of 7.2-53 %. The aim of this study was to increase the efficacy of surgical approach to the management of mechanical jaundice non-malignant etiology associated with MOF by prognosing, duly prophylaxis, and complex management of the accompanying complications. Analysis was carried out on the results of treatment of 128 patients, with mechanical jaundice non-malignant origin. All patients were distributed into two groups: Comparism group (82 patients) who underwent the standard methods of diagnosis and the traditional way of treatment. Basic group (46 patients) in which the method of diagnosis was serum concentration of Interleukin-8(IL-8), circulatory immune complexes, lymphocytotoxicity. With the help of clinical, biochemical and immunological findings, criteria for the risk of development of multiorganic failure in the preoperative period was defined. This enabled more early prediction of MOF and more rational surgical tactics. Based on this, subdivision of patients with more severe attacks and high risk of MOF was allocated. For such patients, the more rational surgical approach was 2-step operative tactics with the initial use of biliary decompression, the basic radical procedure followed by bioabsorbtion with the use of cryoconserved xenohepatocytes and xenosplenocytes if necessary. This worked out approach enabled us to reduce the postoperative morbidity from 12.2% to 6.5% and reduce mortality from 9.8% to 4.3%.