Surgical treatment of proximal biliary and biliovascular lesions

Objective. To determine the indications for resective surgical interventions in various types of biliary tract injuries, to assess the risk and effectiveness of such operations and the rates of postoperative complications and mortality. Materials and methods. From January 2004 to June 2024, 36 liver resections for biliary tract damage were performed at the Department of Liver Transplantation and Surgery of the Shalimov National Research Centre for Surgery and Transplantation of the National Academy of Medical Sciences of Ukraine. The criterion for inclusion in the study was liver resection for iatrogenic biliary tract damage. Results. Indications for liver resection with biliary reconstruction were severe bile duct damage, its combination with vascular damage, a long period after biliary tract injury with necrotic or atrophic changes in the liver. Preoperative preparation is aimed at eliminating complications caused by biliary tract damage. The choice of surgical tactics depended on the level of bile duct injury and the nature of the combined vascular damage. Most severe complications were associated with the development of liver failure and sepsis. Mortality in the postoperative period was 19.4% (7 patients died) and was associated with the inability to sufficiently correct septic complications at the preoperative stage. Conclusions. Liver resection in many patients is the most effective treatment for iatrogenic biliary tract injury. Given the potentially high rates of complications and mortality in this group of patients, successful treatment requires clear indications for resection. Liver resection for biliary tract injuries should be performed in conditions of complete elimination of previous complications and compensation of the patient's condition. Prevention or effective treatment of chronic purulent inflammation of the biliary tract and sepsis is the main task of the surgeon at the preoperative stage, as they cause mortality in this group of patients.