Percutaneous transhepatic cholangiostomy in children

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Abstract

Introduction. Congenital malformations of the bile ducts, complicated course of cholelithiasis, strictures of biliodigestive anastomoses, tumors of the pancreatobiliary zone can lead to mechanical jaundice. It is not always possible to perform unloading cholecystostomy for the urgent bile derivation, to stent bile ducts with retrograde endoscopy; more so, to perform radical surgery under hyperbilirubinemia is a risky intervention that can cause complications. Then, percutaneous transhepatic cholangiostomy becomes a method of choice. We present our own experience of interventional surgical procedures on the biliary ducts in children with biliary obstruction.

Material and methods. 14 patients, aged 6–17 years , who had 47 interventions were included in the study.

Results. In all cases, percutaneous transhepatic cholangiostomy was successful and stopped biliary hypertension. Stricture recanalization after balloon dilation was successful in 4 patients with hepaticoejunoanastomosis stenosis. Puncture neoanastomosis of the disconnected posterior-sectorial duct was performed in 2 patients. External drainage of the bile ducts with subsequent radical treatment was performed in 10 patients; the “Rendez-vous” technique - in 1 patient.

Conclusion. Interventional surgical procedures on the bile ducts in children is an effective method of treatment in various clinical situations leading to mechanical jaundice. In some cases, it can effectively stop biliary hypertension. And such methods as recanalization of strictures and puncture neoanastomosis can be a final minimally invasive technique for treating disorders of bile outflow.

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About the authors

Olga V. Melekhina

Loginov Moscow Clinical Research and Practical Center

Email: melekhina530@gmail.com
ORCID iD: 0000-0002-3280-8667
Russian Federation, 111123 Moscow

Yu. Y. Sokolov

Central Clinical Hospital with Out-patient Unit, Department of Presidential Affairs of the President of the Russian Federation; Russian Medical Academy of Continuing Professional Education, Ministry of Health of the Russian Federation

Email: sokolov-surg@yandex.ru
ORCID iD: 0000-0003-3831-768X
Russian Federation, 121359 Moscow; 125993 Moscow

A. M. Efremenkov

Central Clinical Hospital with Out-patient Unit, Department of Presidential Affairs of the President of the Russian Federation; Russian Medical Academy of Continuing Professional Education, Ministry of Health of the Russian Federation

Author for correspondence.
Email: efremart@yandex.ru
ORCID iD: 0000-0002-5394-0165

Head of the Pediatric Surgery Department, Central Clinical Hospital with Out-patient Unit, Department of Presidential Affairs of the President of the Russian Federation

Russian Federation, 121359 Moscow; 125993 Moscow

E. N. Solodinina

Central Clinical Hospital with Out-patient Unit, Department of Presidential Affairs of the President of the Russian Federation; Central State Medical Academy, Department of Presidential Affairs of the President of the Russian Federation

Email: solodinina@gmail.com
ORCID iD: 0000-0002-5462-2388
Russian Federation, 121359 Moscow; 121359 Moscow

A. P. Zykin

Central Clinical Hospital with Out-patient Unit, Department of Presidential Affairs of the President of the Russian Federation; Russian Medical Academy of Continuing Professional Education, Ministry of Health of the Russian Federation

Email: alr-z@yandex.ru
ORCID iD: 0000-0003-3551-1970
SPIN-code: 4048-7765
Russian Federation, 121359 Moscow; 125993 Moscow

T. V. Utkina

Russian Medical Academy of Continuing Professional Education, Ministry of Health of the Russian Federation

Email: efremart@yandex.ru
Russian Federation, 125993 Moscow

K. A. Barckaja

Russian Medical Academy of Continuing Professional Education, Ministry of Health of the Russian Federation

Email: efremart@yandex.ru
Russian Federation, 125993 Moscow

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Supplementary files

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2. Fig. 1. The moment when the needle is entering the bile duct lumen is visible on the ultrasound monitor. It is subjectively felt as “needle dropping”, bile is aspirated into the syringe.

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3. Fig. 2. Cholangiogram. A soft guidewire with J-shaped tip was inserted into the bile duct lumen through the needle channel.

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4. Fig. 3. The depth of «waist» relative to the lumen is assessed by X-ray (а). The pressure of full extension of the «waist» is estimated on the gauge (б).

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5. Fig. 4. Drainage: distal end was located below the stricture, as far as possible far in the Roux-en-Y-loop, and lateral holes were located above the stricture, at the level of the segmental bile ducts. The internal drainage segment (between proximal and distal openings) allows bile to flow into the intestine. The external drainage segment provides constant flow of the bile in the intestine (between proximal and distal openings) (a, б), and the external drainage segment provides constant access to the ducts (в).

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Copyright (c) 2023 Melekhina O.V., Sokolov Y.Y., Efremenkov A.M., Solodinina E.N., Zykin A.P., Utkina T.V., Barckaja K.A.

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