Role of autoimmune processes in the initiation of biliodigestive anastomoses leakage in conditions of cholangitis.

OBJECTIVE

Aim: To determine the role of autoimmune reactions on healing of BDA in patients with cholangitis.

PATIENTS AND

METHODS

Materials and

Methods

166 (100%) non-oncology patients with cholangitis, were divided into three groups. Group I - 92 (55.4%) patients - cholangitis caused by choledocholithiasis. Endoscopic papillotomy with lithoextraction or choledocholithotomy were performed. Group II - 48 (28.9%) patients - cholangitis due to benign strictures of the bile ducts - patients underwent reconstructive interventions. Group III - 26 (15.7%) patients - cholangitis in presence of biliodigestive anastomosis, which required reconstruction.

RESULTS

Results

Autoantibodies to own tissues were found in blood plasma of some patients of II and III groups. Morphological examination of the liver tissue of these patients revealed changes in the form of bridge-like and stair-like necrosis with lymphocyte-macrophage infiltration, which is characteristic of autoimmune damage. In parallel with this, a decrease in the functional condition of the liver was ascertained, which had a decisive effect on the chemical composition of bile, caused sedimentation processes and the appearance of sludge. As a result of reduction of reparative processes in the area of biliodigestive anastomosis, anastomotic leakage developed, then - stenosis.

CONCLUSION

Conclusions

With a long duration of chronic cholangitis, destructive changes occur in the tissues of the liver and bile ducts, which are caused by autoimmune reactions. The presence of autoimmune antibodies is a marker of a high probability of deterioration of reparative processes in the area of the biliodigestive anastomosis and contributes to the development of anastomosis leakage.