Critical moments of the postoperative period, postdecompression liver dysfunction in surgery for non-tumor obstructive jaundice

• Main Author: S.I. Savoliuk
• Format: Article
• Language: English
• Published: Publishing House Zaslavsky 2020-02-01
• Series: Mìžnarodnij Endokrinologìčnij Žurnal
• Subjects: non-tumor obstructive jaundice; methods of surgical bilia­ry decompression; degree of postoperative safety; postdecompression liver dysfunction; critical moments of postdecompression period
• Online Access: http://iej.zaslavsky.com.ua/article/view/199123

Background. Modern theories of the pathogenesis of postdecompression liver dysfunctions are trying to focus on a separate pathophysiological side of the complex process and the mechanisms of initiation. However, only an integrated approach allows you to objectively determine the mechanisms of development of liver dysfunction in the postoperative period. The purpose was to determine the characteristics and regularities of the influence of traditional and minimally invasive methods of biliary decompression on the functional state of the liver from the position of postdecompression liver dysfunction in patients with obstructive jaundice of a non-tumor etiology. Materials and methods. The results of surgical treatment of 510 patients with non-tumor obstructive jaundice were analyzed. Results. Stratification of patients according to the process and methods of biliary decompression allowed evaluating the impact of the methods of surgical treatment on the degree of hepatic dysfunction in the postoperative period by changing its prognostic predictors. With this, postoperative assessment of the safety of conventional and minimally invasive internal and external biliary decompression was performed in terms of the possible initiation and progression of postdecompression liver dysfunction. Conclusions. The development of approaches to differentiated choice of surgical treatment and methods for its implementation from the point of view of the degree of postoperative safety of surgical intervention methods and postdecompression burden of existing liver dysfunction led to a redistribution in the structure of surgical interventions performed in patients with non-tumor obstructive jaundice in favor of minimally invasive correction, the creation of reasonable protocols for perioperative follow-up helped reduce postoperative complications by 10.26 % (from 16.87 to 6.61 %), postdecompression liver dysfunction — by 9.19 % (from 10.84 to 1.65 %) and mortality rate — by 6.4 % (from 7.23 to 0.83 %).