Minimally invasive surgical procedures for obstructive jaundice: prediction of complications and mortality

Objective. To improve the outcomes of surgical treatment for patients with obstructive jaundice (OJ) through the differentiated application of combined minimally invasive technologies.

Materials and methods. The results of treatment of 301 patients with OJ of various etiologies and severity levels were analyzed.

Results. Benign diseases (BD) of the hepatopancreatobiliary region (HPBR) causing OJ were observed in 175 (58.1 %) patients, while malignant neoplasms (MN) were identified in 126 (41.9 %) cases. The E.I. Galperin classification of OJ was used: class A included 117 (38.9 %) patients, class B – 132 (43.9 %), and class C – 52 (17.3 %). The method of treatment was chosen depending on the etiology and severity of OJ, the level of bile ducts obstruction, and the comorbidity. Both single-stage and two-stage procedures were performed, including cholecystectomy, as well as retrograde and anterograde endobiliary and transpapillary interventions. A significantly higher mortality rate was observed in patients with OJ caused by MN of the HPBR – 43 (34.1 %) cases. Mortality in patients with BD was 17 (10.3 %) and was associated with the presence of acute cholecystitis and paravesical purulent-septic complications. Multivariate logistic regression and ROC analysis confirmed that preoperative risk factors such as malignant etiology, class C of OJ, hyperphosphatasemia, and comorbidities (bronchial asthma, coronary heart disease, post-infarction cardiosclerosis, diabetes mellitus, and consequences of cerebrovascular disorders) increased the risk of mortality in patients with OJ significantly.

Conclusions. The treatment of patients with HPBR diseases complicated by OJ requires a differentiated approach to the selection of the optimal extent and staging of combined surgical interventions. The developed mathematical model of predicting the risk of adverse outcomes in OJ demonstrated high accuracy confirming its significance as a tool for optimizing treatment strategies for the patients with HPBR diseases complicated by OJ.