[Analysis the efficacy of preoperative biliary stent placement in patients with malignant obstructions of distal choledochus]. / Analiza efikasnosti preoperativnog plasiranja bilijarnog stenta u pacijenata sa malignim opstrukcijama distalnog holedohusa.

ABSTRACT

BACKGROUND: In a very short time, malignant obstructions of distal choledochus cause a lot of damage to the liver function that may result in serious intra operative and postoperative complications and consequent high hospital mortality. Contradictory results with respect to the recovery of the liver function and origin of intra operative and postoperative complications lead us believe in the necessity of the evaluation of the preoperative placement of billiar stent in these patients, knowing that these patients see the doctor in the advanced stage of the disease with the relatively high level of the liver function damage. The goal of this research was a quantitative and qualitative analysis of intra operative and postoperative complications as well as high hospital mortality in both groups of subjects so that through this kind and scope of complications and mortality rate we could indirectly reach the conclusion relating to efficiency of the billiar stent placement. Another goal of the research was the analysis of liver tests before the operation and ten days after the operation with both groups of subjects so that, based upon the speed of their normalization, the conclusion could be reached in relation to the speed and level of the liver function recovery after the performed pancreatoduodenectomy. RESULTS: The subjects from the first group had more expressed symptoms of jaundice and high temperature and fever whereas in respect to the other presented symptoms there was no statistically significant difference. Preoperative values of ALT and AST values and the total values of bilirubin and C-reactive protein were statistically significantly higher in the first group of subjects (p<0.05). Contrary to that, ALP and GGT enzymes value were higher but there was no statistically significant difference between the compared groups. After the operation the normalization of all mentioned parameters of the liver function occurs in both groups of subjects but ALT, AST, ALP and GGT enzymes values and total bilirubin values in the first group of subjects were closer to the reference values. Based upon these data we can conclude that the liver function recovery also was better and faster. By analyzing intra operative complications no statistically significant difference was found between the compared groups. The total ratio of postoperative complications was 32 %, compared to 40 %, which is not a statistically significant difference. With respect to fistula and infections there were no statistically significant differences. Other postoperative complications in both groups were almost equally present and are not statistically significant. CONCLUSION: Better liver function recovery in the first group of subjects and the equal ratio of complications in both group of subjects, justifies the application of preoperative placement of billiar stent under our conditions.