INTRODUCTION

Postoperative bile duct strictures are one of the most urgent problems in hepatopancreatobiliary surgery. Every year, the number of patients with iatrogenic cicatricial strictures tends to increase against the background of the spread of laparoscopic technologies for the treatment of cholelithiasis. Recently, minimally invasive endoscopic interventions, which are a full-fledged alternative to open reconstructive surgeries, play an increasingly important role in the treatment of benign strictures of the bile ducts.

CLINICAL CASE

A 34-year-old patient underwent staged treatment at the Vishnevsky National Medical Research Center of Surgery about the complex high postoperative stricture of the common hepatic duct, which arose as a result of an injury to the duct during a previously performed laparoscopic cholecystectomy.

RESULTS

The patient underwent four step-wise stenting of the bile ducts within 1 year with a successive increase in the number and diameter of plastic stents. Despite the initial full block of the common hepatic duct, confirmed by preoperative fistulography and MRI, during the first two retrograde interventions using the “rendez-vous” technique, it was possible to successfully recanalize the stricture followed by bilateral stenting. As a result of the treatment, the lumen of the common hepatic duct was observed to flatten to actually normal values. The total duration of treatment was 12 months, and the duration of the relapse-free period was 14 months.

CONCLUSION

The use of minimally invasive endoscopic technologies as part of an integrated approach to the treatment of a patient with postoperative stricture of the common hepatic duct made it possible to obtain a good clinical effect and avoid open reconstructive intervention. Despite the multi-stage endoscopic treatment, the short postoperative period at each stage led to a quick return of the patient to her usual way of life without the need for long-term rehabilitation.