SKUMS A. Prophylaxis and surgical correction of bile duct injuries following open and laparoscopic cholecystectomy.

The dissertational work is devoted to system of measures of prophylaxis of bile duct injuries following open and laparoscopic cholecystectomy and also ways of their early diagnostics and the proved methods of surgical correction.The primary factors of risk, reason, kinds and mechanisms of damages of bile duct are determined. The most significant anatomical variants of conjunction of a vesical and hepatic duct were systematized, their impact on the duct damage was determined during cholecystectomy. It was proved that electric burn causes perforation of the duct wall in the first 3 days after operation or formation of a posttraumatic cicatrical stricture. The duct's ischemia was identified as one of the main reasons of formation of a stricture. The cellular and humoral parameters of systemic and local immunity of hepatobiliary system are investigated. The specific features of the bile ducts injuries following laparoscopic cholecystectomy and their significance in a choice of method correction were establ ished. The most significant factors, determining the surgical intervention result, were determined using multifactorial analysis. The complex approach to treatment of the patients with trauma of bile ducts is developed. Is was proved, that high hepaticojejunostomy is the method of choice in the treatment of complete bile duct injuries following open and laparoscopic cholecystectomy, that in 94,6% of observations provides the good and satisfactory remote result.The complex system of pre- and intraoperative prophylactic measures of bile duct injuries following laparoscopic cholecystectomy was elaborated, what was permitting to reduce frequency of damage of bile ducts (to 0,13%).