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Aim. Define the safety and effectiveness of rendezvous technique for choledocholithiasis.Material and methods. We performed a retrospective and prospective analysis of the results in percutaneous transhepatic access to the bile ducts and endoscopic intervention in the rendezvous technique for choledocholithiasis in 100 elderly patients. The patients were divided into 2 groups for 50 people. The implementation of the rendezvous began from the antegrade stage in patients from group I; in patients of group II – from the retrograde stage. Postmanipulation complications and failures were When analyzed. The control point of the study is the identification of complications associated with manipulation from the next stages of the rendezvous technique.Results. We revealed a direct dependence of the results in sequence of rendezvous technique for elderly patients with choledocholithiasis and obstructive jaundice. This fact allows recommending percutaneous transhepatic access before endoscopic intervention for these patients with statistical significance. The frequency of complications and failures in patients of group I was 18%, in group II – 52%. This allows for such patients percutaneous transhepatic access before endoscopic intervention in the rendezvous technique. The frequency of complications and failures in patients of group I was 18%, in group II – 52%.Conclusion. Dilatation of intrahepatic segmental and subsegmental 2 and 3 biliary ducts with moderate and severe obstructive jaundice is a predictor of complications with ineffective endoscopic approach. In such situations, preventive antegrade drainage of the biliary tract with rendezvous technique makes possible to prevent cholangitis, effectively eliminate biliary hypertension, clarify the severity of stenosis of the papilla with antegrade balloon revision, and also secure delayed endoscopic resolution of biliary pathology.

Aim.To determine the role of antegrade X-ray surgical interventions in the treatment of benign postoperative biliary strictures.Material and methods.A retrospective analysis of treatment of 36 patients with benign biliary strictures was performed. Isolated stricture of biliodigestive anastomosis was diagnosed in 25 cases, partial clipping of common hepatic duct proximal to biliodigestive anastomosis – in 3 cases, partial clipping of bile duct – in 3 patients, isolated biliary strictures – in 5 patients including 4 of them with stricture within previously deployed T-shaped drainage. At the first stage, percutaneous transhepatic cholangiostomy was performed. According to antegrade cholangiography data, structure type “+1, +2” by H. Bismuth classification in modification of E. I. Galperin was diagnosed in 16 (55.2%) patients, proximal biliary strictures (“0”–“−2”) in 13 patients. Three patients with partial clipping of common bile duct and 4 patients with benign biliary stricture in the area of previously deployed T-shaped drainage were not classified. Recanalization of strictures by “catheter-guide” system was followed by antegrade dilatation of the stricture. Final stage was frame external-internal drainage for 6–12 months with stepwise redo balloon dilatation every 3 months (35 patients). The criterion for the end of minimally invasive treatment was the absence of balloon waist in the stricture zone observed during the next procedure but not earlier than in 6 months from primary balloon dilatation. Surgical correction was indicated for recurrent stricture.Results.Direct technical success was achieved in 35 patients. There was 1 case of recurrent strictures within 1 year among 3 cases of primary repair of biliary strictures in the area of previously installed T-shaped drainage. Resection of common bile duct stricture was followed by Roux-en-Y hepaticojejunostomy. Recurrence-free period among 36 patients ranged from 1 to 10 years, median – 56 months. There were no mortality and complications after X-ray surgery.Conclusion.Antegrade recanalization and balloon dilatation of the stricture followed by long-term external-internal biliodigestive frame drainage are effective for both stricture of biliodigestive anastomosis and partial clipping of bile duct. Conventional surgical procedures should be preferred for cicatricial strictures of extrahepatic bile ducts after previous T-shaped drainage deployment.

Aim. To improvethe efficiency of X-ray treatment of postoperative complications (duodenal and biliary fistulae, intraabdominal iatrogenic bile collections). Material and Methods. Percutaneous transhepatic biliary drainage was carried out in 11 patients with nondilated intrahepatic bile ducts. Failure of duodenal stump after previous stomach resections in 5 patients, presence of external biliary fistulae after surgery on gall bladder and common biliary duct in 3 patients and severe pancreonecrosis in 3 cases led to need of antegrade transhepatic cholangiostomy. Results. Antegrade transhepatic cholangiostomy gives an ability to close duodenal fistulae in 5 patients and biliary fistulae in 3 patients with iatrogenic injury of common biliary duct. Percutaneous transhepatic biliary drainage was used in treatment of 3 patients with severe pancreonecrosis. There were 2 complications of antegrade transhepatic cholangiostomy such as hepatic subcapsular hematoma and porto-biliary fistula which were cured effectively using minimally invasive methods (percutaneous drainage of hematoma and disintegration of porto-biliary fistula by filling of intrahepatic canal). Conclusion. Antegradetranshepaticcholangiostomy in case of nondilated intrahepatic bile ducts differs from traditional technique. Often it assumes contrasting of biliary tree using any available way and demands strict compliance of manipulation technology