Smachylo R. Clinical and experimental substantiation of surgical tactics and treatment of biliary fistula.

The thesis is dedicated to improving of outcomes in patients with bile leaks and biliary fistula by refinement of existing and developing of new methods of surgical treatment and individualization of treatment strategy based on the study of various mechanisms of their development, risk prediction, development of preventive programs in patients at high risk. The experimental research on reproduction of model of biliary fistula and subsequent morphological study of the wall of the common bile duct, fistula canal, liver, determined the optimal time for reconstructive surgery. Immune studies in different periods of existence of biliary fistula have found time dependence of immunopathological reactions with the development of autoimmune reactions on the 3-4th week of biliary fistula persistence, while the inflammatory reaction in bile duct subsided. In a large clinical material types of bile leak presentation were demonstrated: intraabdominal and intrahepatic bilomas, bile peritonitis, external bile leaks. It was proved that the severity of condition of patients with intra-abdominal complications of bile leaks did not depend on the severity of biliary duct injury. Tactical approaches in this category of patients were defined with preferred use of mini-invasive technologies to evacuate pathological content. The options for further treatment of persistent biliary fistula were proposed. In "minor" injuries of common bile duct and obstruction of its distal portion modern endoscopic and percutaneous transhepatic interventions were applied. The technique of biliodigestive anastomosis depending on its type, condition of wall was defined. For small diameter ducts, anastomosis "end to side", fragile duct precise everting monofilament single sutures anastomosis is indicated.