Bile Ducts Stones After Pancreatoduodenal Resection: Risk Factors and Treatment

Pancreaticoduodenectomy (PDR) is the primary surgical treatment for periampullary malignancies. Late complications after PDR occur in 31.5 % of cases. The most serious of these are biliary anastomotic strictures and bile duct stone formation (biliary complications), which can occur in up to 10.2 %.

Aim: to analyze the literature concerning the causes of biliary complications, particularly stone formation in the bile ducts after PDR, and the treatment methods for these patients.

Key points. Predisposing factors for stone formation after PDR include bile stasis (due to anastomotic stricture), remnants of suture material or clips, infection, and reflux of intestinal contents into the bile ducts. The choice of a minimally invasive treatment method for patients with bile duct stones after PDR depends on the qualifications of specialists and the technical resources of the medical institution. The endoscopic approach is characterized by rapid clinical success and shorter hospitalization but has a lower technical success rate due to altered anatomy. Percutaneous access is a highly effective minimally invasive treatment for late biliary complications, which can be used as a firstline option or in cases where endoscopic intervention has failed. The use of absorbable suture material, minimizing the number of anastomotic sutures, various hepaticoplasty techniques, and avoiding excessive bile duct mobilization may help prevent stone formation after pancreaticoduodenectomy.

Conclusion. Bile duct stones as a complication of the late postoperative period of PDR require highly qualified surgical care, including minimally invasive techniques. Further research is needed to identify possible ways to prevent and improve treatment methods for biliary complications of postpartum biliary reflux.

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