SURGICAL TREATMENT OF OBSTRUCTIVE JAUNDICE IN BENIGN DISEASES OF THE BILIARY TRACT

Obstructive jaundice (OJ) remains a significant clinical and diagnostic challenge due to the high risk of hepatic failure and homeostasis disturbances. The main causes of OJ include biliary calculi (≈50%), malignant tumors (up to 40%), and biliary strictures (≈10%). Postoperative complications occur in 15.6-63.4% of cases, with mortality rates reaching 25-30%, highlighting the need for timely biliary decompression and the use of minimally invasive treatment methods to improve outcomes.

To analyze the outcomes of the implementation and optimization of surgical treatment methods in patients with benign obstructive jaundice, with a focus on the effectiveness of modern surgical and minimally invasive technologies.

Single-center prospective non-randomized comparative study.

The study analyzed data from 142 patients with cholelithiasis and benign obstructive jaundice (BOJ) (33% men, 67% women; mean age 64.5±5.4 years). Patients were divided into a study group (n=69), treated using newly developed surgical techniques, and a control group (n=73), treated with conventional surgical approaches. The primary causes of BOJ were calculous cholecystitis with multiple choledocholithiasis (≈35-36%), Mirizzi syndrome, and postcholecystectomy syndrome. Disease severity was evenly distributed among mild, moderate, and severe forms, with no statistically significant differences between the groups. In the study group, choledochoduodenostomy using the clinic-developed technique was more frequently performed (77%), whereas in the control group the Yurash-Vinogradov technique predominated (71%).

In patients with BOJ, the study group demonstrated a significant reduction in postoperative complications according to the Clavien-Dindo classification (7.2% vs. 24.7%, p=0.005) and no mortality, whereas four deaths (5.5%) occurred in the control group. Postoperative pain intensity was significantly lower in the study group on postoperative day 7 (p=0.028) and at discharge (p=0.007). The mean length of hospital stay was 8.3±0.7 days compared to 12.8±0.8 days in the control group (p=0.019). The incidence of restenosis decreased from 6.8% to 2.9% (p=0.023), and hospitalizations for late complications were significantly reduced, with a relative risk of 5.67 (p<0.001). Quality-of-life scores assessed by the SF-36 and GSRS questionnaires were significantly higher in the study group at 6 and 12 months postoperatively (p<0.05). The developed surgical approaches were associated with fewer postoperative complications, shorter hospital stay, reduced postoperative pain, and more favorable postoperative quality-of-life scores during follow-up.

The developed surgical techniques for benign obstructive jaundice were associated with lower postoperative complication rates (7.2% vs. 24.7%, p=0.005), lower postoperative pain intensity, shorter hospital stay, and more favorable postoperative quality-of-life scores during follow-up. These findings support the clinical relevance of the proposed approaches, although they should be interpreted in the context of the non-randomized study design.