An: 2019, Nr.1, Articol Nr. 9

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      ANATOMY OF COMMON BILE DUCT AND SURGICAL TREATMENT OF MECHANICAL JAUNDICE – CLINICAL RETROSPECTIVE PERSONAL TRIAL (Abstract): The most important issue a surgeon is faced with is to establish whether the patient displays a “medical” or a “surgical” jaundice, the latter being caused by an obstruction, which must be removed through a surgical procedure. Material and method: This is a retrospective trial which includes 34 patients admitted to hospital with a mechanical jaundice diagnosis, who had been operated on in the Surgery Ward of the Military Emergency Clinical Hospital «Dr.Iacob Czihac» in Iaşi (Romania) during last five years. The mechanical jaundice causes had mainly to deal with a malignant tumoral pathology as follows: 23 were caused by pancreatic head neoplasms, 3 were common bile duct Klatskin tumors, 3 were post-surgery mechanical jaundice cases, 2 pseudo-tumoral pancreatitises and 3 cases of common bile duct post-cholecystectomy reformed lithiases. In each group of cases a different surgical technique was applied, which the author analyzed in greater detail in the paper. Discusions: Based on the frequency of cases (an average of 1 case to each 1.5 months), the etiology was mainly represented by malignant tumors, but also by common bile duct lithiases. The medical treatment geared up to prepare the surgical intervention. The surgical treatment adjusted to each individual case. The outcomes had to deal with the severity of the lesion, patient’s age, general condition, how early or late the surgical intervention occurred and the nature of the lesion. Conclusions: One of the most important measures taken in these cases was to adopt a customized surgical strategy and technique in each individual case, based on its etiology and the level of mechanical obstruction.

Key words: MECHANICAL JAUNDICE, BILE-DIGESTIVE DERIVATION, DUODENUM PANCREATIC HEAD RESECTION