Obstructive jaundice: routing, diagnostics, treatment tactics

Abstract

Aim. To analyze three-level system of medical care for different categories of patients with obstructive jaundice on the example of Pavlov University.Materials and methods. The paper presents a retrospective analysis of treating patients with obstructive jaundice. The analysis covered the period from January 2015 to April 2023 and involved an etiology of obstructive jaundice, range of performed surgical interventions, postoperative complication rate, and mortality.Results. The study involved 2494 patients, including 1569 (62.9%) with cholelithiasis. The total mortality accounted for 7.2%, the incidence of postoperative complications – 13.9%. A choice of decompression procedure in patients with malignant tumors depended on the block level. Interventions included percutaneous transhepatic drainage, cholecystostomy, stenting of common bile duct. Hybrid surgery was performed in patients with calculous cholecystitis and choledocholithiasis. A number and size of concrements, a diameter of common bile duct influenced the choice of interventions and their volume. Two-stage tactics for stricture of biliodigestive anastomosis included percutaneous transhepatic drainage and reconstructive surgery. Endoscopic intervention was performed for choledocholithiasis. Procedures for stricture of biliary anastomoses after orthotopic liver transplantation involved endoscopic papillosphincterotomy, balloon dilatation of stricture and stenting of bile duct. Management of obstructive jaundice against the background of gestation included endoscopic papillosphincterotomy, lithoextraction, and, if necessary, treating the pregnancy termination threat.Conclusion. The routing of patients with obstructive jaundice to the 2nd and 3rd level of healthcare units is found necessary to be differentiated, depending on the etiology and severity of their condition. Obstructive jaundice in pregnant women requires the patient to be referred to the hospital of the 3rd level. Creation of a shared dispatch service responsible for a certain territory can reduce a number of routing stages.