Surgical treatment of vasculobiliary liver damage

Objective. To evaluate surgical tactics for iatrogenic vasculobiliary liver damage and the results of their treatment. Materials and methods. From January 2004 to December 2024, 46 liver resections were performed at the Department of Liver Transplantation and Surgery of the O. O. Shalimov National Scientific Center for Surgery and Transplantology of the National Academy of Medical Sciences of Ukraine for damage to the bile ducts alone or to the bile ducts and liver vessels. The average age of patients was (53 ± 12.9) years, with women accounting for the vast majority – 58.7%. The inclusion criterion for patients in the study was liver resection due to iatrogenic biliary or vasculobiliary damage. The exclusion criterion for patients in the study was secondary biliary cirrhosis of the liver. Results. In most patients (41.3%), damage was detected more than 1 month after laparoscopic cholecystectomy, and an average of (8.2 ± 15.5) months passed before referral to a specialized center. According to the Strasberg-Bismuth classification, E4 damage was most commonly detected (54.4%), less commonly E5 (23.9%), E3 (13%), and C (8.7%). Vascular lesions were found in 76.1% of patients, most often affecting only the right hepatic artery (41.3%) or in combination with the right branch of the portal hepatic vein (19.6%). The main types of surgical interventions performed were: right-sided extended hemihepatectomy (41.3%), right-sided hemihepatectomy (28.3%), and trisectionectomy (15.2%). In addition, 8.7% of patients required vascular reconstruction. The postoperative mortality rate was 15.2%. Conclusions. Resection remains the only justified surgical tactic in patients with iatrogenic vesiculobiliary liver damage, especially against the background of ischemic parenchymal damage and concomitant purulent-septic complications. High rates of postoperative morbidity and mortality in these patients justify the need for clear stratification of indications for liver resection, performing it in conditions of complete sanitation of the infectious focus and stabilization of the patient's somatic condition. Effective control of sepsis and chronic inflammation in the biliary tract plays a key role in reducing the risk of liver failure, failure of reconstructive anastomosis, and mortality.