[Treatment of cicatricial strictures fo hepatic ducts]

Retrospective evaluation of experience in treatment of 378 patients (1972-1997 years) with cicatricial stricture of hepatic ducts is presented. For the period for 1972 to 1986 years the basic principle consisted in obligatory use of a drainage--frame for prolonged (not less than 2 years) drainage of the biliary anastomosis aimed at a decrease of the recurrence risk. Changeable transhepatic drainage (CTD) was used. 199 patients were operated on, 18 died. In postoperative period a number of specific complications caused by CTD were observed: leak into infradiaphragmatic space (hemobilia, bile biliduodenal fistula, etc.). At follow-up period after restorative operations (34) relapse of cicatricial stricture was observed in 8 patients, which was a consequence of complications due to CTD. After reconstructive operations CTD was removed in 109 patients, relapse being detected in 5 (4.5%). Atraumatic needles with inert monifilament sutures as well as resolving suture threads enabled creation of high bilio-intestinal anastomoses without drainage-frame. Since 1987 to 1997 years 130 patients were operated on. Dissection of the hepatic ducts was made proximally to the cicatricial tissues, longitudinal cut of the left hepatic duct was performed. Atraumatic needles with threads of small size were used, the bilio-intestinal anastomosis was established by one layer nodular suture with nodules exteriorly faced and without seizure of intestinal mucous membrane. Complications in postoperative period were observed in 24 patients, no lethal outcomes occurred. In late postoperative period unsatisfactory results were documented in 7 patients. At present time we give preference to operations without drainage-frame. CTD is indicated in the presence of severe pyogenic and inflammatory infiltration at hepatic porta with involvement of the bile ducts' walls, cyrrhosis of the liver and portal hypertension hindering hepatic ducts' dissection; cicatricial stricture of the right hepatic duct followed by sclerosing process in sectoral ducts.