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Abstract

Surgical treatment addressed to patients with biliary lesions and benign biliary strictures is a current problem for discussion which lead to complex approach of interdisciplinary research and medical anthropology. The study’s objective was to systematize the experience of treating benign biliary strictures, analyzing in complex through the prism of effectiveness and efficacy of treatment outcomes. There are presented the remote results of 203 patients who underwent biliodigestive reconstruction during the 1989-2015 years. The patients from the study were monitored during 2-5 years depending on local anatomical peculiarities at the moment of the reconstructive intervention, as well on remote clinical-evolutive peculiarities, using the score proposed by Terblanche.The reconstructive surgical treatment of benign biliary strictures, classified according to Bismuth, was performed and adapted depending on the level of stricture, with preference of biliodigestive derivations on jejunal loop a la Roux. Reconstructive treatment included: choledochojejunostomy - in 86 (42.4%) cases with type I and II strictures; hepaticojejunostomy - to 102 (50.2%) patients with strictures of type III and in 15 (7.4%) cases of type IV biliary strictures, bihepaticojejunostomy was performed. There were noted the following remote outcomes: very good (Terblanche I) in 123 (60,6%) cases, good (Terblanche II) in 39 (19,2%) cases, relatively satisfactory (Terblanche III) - 18 (8,9%) cases and unsatisfactory (Terblanche IV) in 23 (11,3%) cases. In reconstructive surgery of postoperative biliary strictures, the principle of definitive intervention which solves the qualitative restore of the biliodigestive flow is of priority.