Background : Development of a method for endoscopic treatment of postoperative cystobiliary fistulas of the residual cavity after echinococcectomy from the liver.

Methods : The clinic has developed and applied a method of transfistula endoscopic elimination of cystobiliary fistulas in 13 patients after open echinococcectomy from the liver. Transfistula endovideoscopy of the residual liver cavity is used for functioning drainages of the residual liver cavity (CL4, CL5).

Results : In order to eliminate the biliary fistula, the minimum effective energy level for the coagulation mode (60-80 W) was used. Bile ducts larger than 0.3 mm in diameter were coagulated only when reliable contact was achieved between the electrode and the wall of the bile duct, and, for reliability, coagulation was carried out along the circumference of the duct. In order to avoid certain difficulties associated with coagulation, it is necessary to use the following techniques: the axis of the instrument is moved away from the zone of direction of the bile flow to detect the source of bile leakage; the instrument is retracted from the duct to be coagulated to the maximum possible distance, allowing coagulation to be carried out with the withdrawn loop. At the end of the intervention, it was considered advisable to conduct a final examination of the residual cavity with minimal irrigation pressure, so that no small fistulas remain visible. No complications were observed.

Conclusions : The developed endoscopic method for eliminating cystobiliary fistulas from the residual cavity is safe, minimally invasive, which helps prevent repeated surgical interventions and reduce postoperative bed days.