Susak YM, Markulan LL, Lobanov SM, Palitsya RY, Rudyk MP, Skivka LM. Effectiveness of a new approach to minimally invasive surgery in palliative treatment of patients with distal malignant biliary obstruction. World J Gastrointest Surg 2023; 15(4): 698-711 [PMID: 37206076 DOI: 10.4240/wjgs.v15.i4.698]
Corresponding Author of This Article
Mariia P Rudyk, PhD, Associate Professor, Department of Microbiology and Immunology, Taras Shevchenko National University of Kyiv, 60 Volodymyrska St, Kyiv 01033, Ukraine. rosiente@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Prospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Apr 27, 2023; 15(4): 698-711 Published online Apr 27, 2023. doi: 10.4240/wjgs.v15.i4.698
Effectiveness of a new approach to minimally invasive surgery in palliative treatment of patients with distal malignant biliary obstruction
Yaroslav M Susak, Leonid L Markulan, Serhii M Lobanov, Roman Y Palitsya, Mariia P Rudyk, Larysa M Skivka
Yaroslav M Susak, Leonid L Markulan, Serhii M Lobanov, Department of Surgery with the Course of Emergency and Vascular Surgery, O.O. Bogomolets National Medical University, Kyiv 01601, Ukraine
Roman Y Palitsya, Department of Abdominal Surgery, National Military Medical Clinical Centre “Main Military Clinical Hospital”, Kyiv 01133, Ukraine
Mariia P Rudyk, Larysa M Skivka, Department of Microbiology and Immunology, Taras Shevchenko National University of Kyiv, Kyiv 01033, Ukraine
Author contributions: Susak YM participated in the design of the study and supervised its implementation; Markulan LL participated in the study as a chief surgeon and performed surgical procedures; Palitsya RY assisted in surgical procedures; Rudyk MP contributed to data collection and participated in statistical analysis; Skivka LM participated in the design of the study, carried out statistical analysis, and wrote the draft.
Institutional review board statement: The study was reviewed and approved by the Committee on Human Rights Related to Research Involving Human Subjects of Kyiv City Clinical Emergency Hospital (Kyiv, Ukraine) (Approval No. 25-15-65).
Informed consent statement: All subjects gave their written informed consent prior to study inclusion.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest to disclose.
Data sharing statement: No additional data are available.
CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and the manuscript was prepared and revised according to the CONSORT 2010 statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mariia P Rudyk, PhD, Associate Professor, Department of Microbiology and Immunology, Taras Shevchenko National University of Kyiv, 60 Volodymyrska St, Kyiv 01033, Ukraine. rosiente@gmail.com
Received: November 17, 2022 Peer-review started: November 17, 2022 First decision: January 23, 2023 Revised: February 5, 2023 Accepted: March 3, 2023 Article in press: March 3, 2023 Published online: April 27, 2023
ARTICLE HIGHLIGHTS
Research background
Patients with distal malignant biliary obstruction (DMBO) may benefit from bile duct (BD) decompression using endoscopic biliary drainage since the procedure reduces pain, relieves symptoms, allows for the administration of chemotherapy, improves quality of life, and increases the survival rate. Cholangitis is one of the main complications of palliative BD decompression in patients with DMBO. Therefore, BD decompression techniques require further improvement to reduce the frequency of cholangitis episodes.
Research motivation
Duodeno-biliary reflux (DBR), among others, is regarded as one of the major systemic causes of cholangitis. The aim of the study was to develop a BD drainage technique for bile diversion from the BD directly into the initial loops of the small intestine, preventing DBR and reflux cholangitis.
Research objectives
To develop a technique for internal-external biliary-jejunal drainage (IEBJD) and assess its effectiveness in comparison to other minimally invasive procedures.
Research methods
In our study, the IEBJD technique was applied using a newly developed biliary-jejunal drainage system. It has two groups of lateral openings (proximal and distal), between which the drainage tube is devoid of openings from the distal border of the tumor to the initial loops of the small intestine. IEBJD was carried out using percutaneous transhepatic access.
Research results
The application of the IEBJD technique contributed to a reduction in the incidence of significant postoperative complications, a delayed onset and shorter duration of postoperative cholangitis, and a considerable improvement in the cumulative survival rate of patients with DMBO.
Research conclusions
The IEBJD technique prevents DBR and reflux cholangitis and can be recommended for the palliative treatment of patients with DMBO.
Research perspectives
The clinical success of the newly developed IEBJD technique in a limited patient group necessitates further evaluation of its efficacy in a larger patient cohort, including those with total bilirubin > 20.47 mg/dL and high operative risk (ASA score of 4).
