1. Disputable issues of biliary drainage procedures in malignant obstructive jaundice
- Author
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O. V. Melekhina, A. Yu. Ogneva, Ruslan Alikhanov, A. B. Musatov, Yu. V. Kulezneva, Mikhail Efanov, and Victor Tsvirkun
- Subjects
Medical institution ,Biliary drainage ,medicine.medical_specialty ,Hepatology ,business.industry ,Optimal treatment ,Gastroenterology ,Surgery ,Medicine ,Treatment strategy ,Tumor type ,Obstructive jaundice ,Biliary decompression ,Drainage ,business - Abstract
Currently, the strategy for preoperative management of patients with malignant obstructive jaundice is not defined. The indications for biliary drainage procedures, the choice of biliary drainage technique and duration of preoperative drainage are still disputable. Analysis of international trials revealed that routine preoperative biliary drainage procedures are not recommended. The indications for biliary drainage in resectable tumors are determined considering severity of obstructive jaundice, cholangitis, dates of major surgery and Bismuth-Corlette tumor type in case of proximal biliary stricture. The choice of retrograde or antegrade preoperative biliary drainage depends on the type of biliary stricture (distal or proximal) and possibilities of medical institution. The majority of studies showed that retrograde (endoscopic) biliary drainage procedures are preferred for distal strictures, antegrade (transhepatic) – for proximal ones. Duration of preoperative biliary drainage depends on normalization of biochemical values. Prolonged drainage may be followed by increased incidence of early postoperative complications. The optimal period of preoperative biliary drainage is 2 weeks. It is necessary to determine the causes of obstructive jaundice as early as possible for successful treatment. This is also essential to define optimal treatment strategy in certain case. Advisability and certain technique of biliary decompression should be determined in accordance with the chosen treatment strategy.
- Published
- 2019