DIAGNOSTIC AND TREATMENT FOR SUMP-SYNDROME AFTER FORMATION OF BILIODIGESTIVE ANASTOMOSIS
Objective. To develop a therapeutic-diagnostic algorithm and to improve the results of treatment for different forms of the sump-syndrome after the biliodigestive anastomoses formed.
Materials and methods. During the period from 2002 to 2016, 74 patients with sump-syndrome including 48 persons after choledochoduodenostomy, 20 patients after “side-to-side” hepaticojejunostomy, six subjects after “end-to-side” hepaticojejunostomy were treated at the Republican Center for Reconstructive Surgical Gastroenterology and Coloproctology. Cholangiolithiasis development in the “sump” after reconstructive operations was observed in 11 (14.9%) patients. The cholangitis severity in the “sump-syndrome” was determined according to the TG13 Classification: Updated Tokyo Guidelines. Stenoses and strictures of the large duodenal papilla occurred in seven (9.5%) patients.
Results. According to the TG13 Classification, of all patients with the syndrome degree I was observed in 19 patients, II — in 18, and III — in 37 persons. The cholangitis clinical picture within the sump-syndrome was observed mainly among the patients after choleodochoduodenostomy (37—50% of patients). In case of the cholangitis degree I conservative treatment was used, degrees II and III — different variants of reoperations and minimally invasive interventions were performed. The syndrome was caused by the inadequately formed anastomoses: high choledochoduodenoanastomosis (24); an inadequate primary variant of reconstruction (2); “side-to-side” hepaticojejunostomy (27); “side-to-side” hepaticojejunostomy on the jejunal loop with Browns bypass (6); “side-to-side” hepaticojejunostomy with strictures of choledochoduodenoanastomosis after their reconstruction (11); choledochoduodenoanastomosis formation with the stump of the duodenum after the stomach resection according to Billroth-II (2).
Conclusion. Minimally invasive retrograde endoscopic interventions and adequate variants of reconstructive operations wide application for managing sump-syndrome will make possible reduction of likelihood of the syndrome development in the long-term period.