Keywords
biliodigestive anastomosis
bile leak
prognosis
minimally invasive interventions
How to Cite
Abstract
In press
Background. Failure of biliary-digestive anastomoses with the development of bile extravasation remains a critical surgical complication associated with a high level of septic conditions and mortality. The lack of objective criteria for early differentiation of the severity of bile leakage necessitates the implementation of prognostic models to objectify surgical decision-making.
Aim. Development of a multifactorial mathematical model and clinical algorithm for early identification of the risk of progression of biliary extravasation in order to optimize the treatment strategy.
Materials and Methods. The results of treatment of 120 patients were analyzed by assessing diagnostic parameters, including the level of interleukin-6, the bilirubin gradient in the exudate, and the anatomical features of the biliary tree. Mathematical modeling and validation of the results were implemented using logistic regression analysis, construction of sigmoidal probability curves, and the bootstrap validation method with SPSS v.26.0 (IBM, USA). The work is a fragment of the research work of the Department of Surgery No.1 of the Kharkiv National Medical University "Development of diagnostic methods and open and minimally invasive technologies for the treatment of diseases and injuries of the thoracic and abdominal organs, vessels of the extremities in patients during wartime" (2024–2028), state registration number 0124U002908.
Research Ethics. The study was conducted in accordance with the main provisions of the Declaration of Helsinki of the World Medical Association (1964–2024). All patients signed a written informed consent for participation and processing of personal data.
Results. Key predictors of bile leak risk were identified, namely: anastomotic re-reconstruction, high strictures, hyperbilirubinemia > 100 μmol/l and hypoalbuminemia. The developed model demonstrated high predictive ability (AUC 0.94; sensitivity 89.3%; specificity 85.7%). The implementation of a three-stage algorithm allowed us to clearly distinguish treatment tactics between conservative management, minimally invasive decompression at an average risk level and urgent relaparotomy with the formation of a "guided fistula" at a high risk level.
Conclusions. The implementation of a three-level risk stratification system provided an objective choice between conservative tactics, minimally invasive interventions and relaparotomy. The use of interventional radiological techniques allowed us to avoid repeated operations and significantly improve treatment outcomes.
Keywords: surgery, biliodigestive anastomosis, bile leak, prognosis, minimally invasive interventions.
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