Intraperitoneal Purulent-Septic Complications in Surgery of Organs of the Hepatopancreatobiliary Zone: Possibilities of Modern Methods of Correction

Introduction. The increase in surgical activity for diseases of the hepatopancreatobiliary system has also led to a higher frequency of postoperative complications. The development of postoperative intra-abdominal purulentseptic complications is one of the main causes of adverse outcomes, which necessitates the improvement of their management methods. The aim of this study was to analyze a large clinical dataset in order to evaluate the incidence and structure of intraabdominal purulent-septic complications after hepatopancreatobiliary surgery. Materials and methods. A large clinical dataset (4,292 cases) collected over five years was analyzed. The overall incidence of postoperative complications after hepatopancreatobiliary surgery was 4.7% (202 out of 4,292). Among these, purulent-septic complications accounted for 55.9%, or 2.63% of all procedures. Results. Among postoperative purulent-septic complications, the most common were suppurative cholangitis (23.0%), infected biliary leaks (19.5%), liver abscesses (15.9%) and perihepatic abscesses (14.2%). Less frequent were peritonitis (10.6%), abscesses of the omental bursa (8.8%), and incomplete intestinal fistulas (8.0%). Discussion. Advances in surgical technology, anesthetic and intensive care support, as well as improvements in the techniques of both primary and repeat hepatopancreatobiliary interventions, have led to a significant reduction in postoperative purulent-inflammatory complications (to 2.63%, compared with 5–6% according to annual reports from the previous five years). Conclusion. The potentially serious outcomes of postoperative purulent-septic complications require further refinement of preventive measures and management strategies.

1. Healthcare in Russia. 2023. Statistical compilation Мoscow; 2023 (In Russ.).

2. Revishvilli A.Sh., Olovyanny V.E., Sazhin V.P., Markov P.V., Gogiya B.Sh., Gorin D.S., et al. Surgical care in the Russian Federation: information and analytical compilation for 2022. Мoscow: Dominant; 2023 (In Russ.).

3. Chubovsky A.I. Analysis of the effectiveness of various methods of laparoscopic surgery in the treatment of diseases of the gallbladder and biliary tract. Medicine. Sociology. Philosophy. Applied research. 2024;4:133–9 (In Russ.).

4. Dynko V.Yu., Kulagin V.V., Gabriel S.A., Mamishev A.K., Durleshter V.M., Makarenko A.S., et al. Modern endoscopic technologies for chronic calcifying pancreatitis. Pirogov Russian Journal of Surgery. 2024;6:15–9 (In Russ., In Engl.). DOI: 10.17116/hirurgia202406115

5. Zagainov V.E., Ruina O.V., Zarechnova N.V., Kuchin D.M., Kiselev N.M., Naraliev N.U., et al. Infectious complications after elective surgeries on the liver and pancreas. Annals of HPB Surgery. 2023;28(4):71–80 (In Russ.). DOI: 10.16931/1995-5464.2023-4-71-80

6. Nartaylakov M.A., Sokolov S.V., Sokolov V.P., Gritsaenko A.I., Mukhamedyanov I.F., Risberg R.Yu. Analysis of complications of antegrade x-ray endovascular interventions in patients with obstructive jaundice. Bashkortostan Medical Journal. 2017;12(4(70)):9–13 (In Russ.).

7. Mazanik A.V., Blakhov N.YU., Chumanevich O.A., Banshchykova K.L., Patsai D.I., Trukhan A.P. Early surgical treatment of severe acute pancreatitis of biliary etiology. Surgery. Eastern Europe. 2023;12(4):417–31 (In Russ.). DOI: 10.34883/PI.2023.12.4.032

8. Staleva K.V., Novikov S.V., Yartsev P.A., Teterin Yu.S., Makarov A.V., Baskhanov Sh.A., et al. Minimally invasive interventions for complications associated with intra-abdominal calculi after laparoscopic cholecystectomy. Pirogov Russian Journal of Surgery. 2024;5:14–20 (In Russ.). DOI: 10.17116/hirurgia202405114

9. Yashnov A.A., Lobanov S.L. Problems of prognosis and early diagnostics of destruction in acute cholecystitis. Novosibirsk: Nemo Press; 2024 (In Russ.).

10. Morikawa T., Ishida M., Iseki M., Aoki S., Hata T., Kawaguchi K., et al. Liver resections in patients with prior bilioenteric anastomosis are predisposed to develop organ/space surgical site infections and biliary leakage: results from a propensity score matching analysis. Surg Today. 2021;51(4):526–36. DOI: 10.1007/s00595-020-02105-4

11. Mentor K., Ratnayake B., Akter N., Alessandri G., Sen G., French J.J., et al. Meta-analysis and meta-regression of risk factors for surgical site infections in hepatic and pancreatic resection. World J. Surg. 2020;44 (12):4221–30. DOI: 10.1007/s00268-020-05741-6

12. Osipov A.V., Demko A.E. Biliary drainage after laparoendoscopic interventions in acute cholangitis. Bulletin of Pirogov National Medical & Surgical Center. 2022;17(2):52–6 (In Russ.). DOI: 10.25881/20728255_2022_17_2_52

13. Okhotnikov O.I., Yakovleva M.V., Grigoriev S.N., Pakhomov V.I., Grigoriev N.N., Okhotnikov O.O. Infectious complications after different percutaneous external-internal biliary drainage techniques for malignant jaundice. Journal of oncology: diagnostic radiology and radiotherapy. 2021;4(2):51–9 (In Russ.). DOI: 10.37174/2587-7593-2021-4-2-51-59

14. Kashaeva M. D., Proshin A. V., Proshina L. G., Shvetsov D. A., Dyukov D. S. Anatomical characteristics and clinical rationale of endobiliary surgeries for benign obstructional jaundice. Vestnik NovSU. 2023;4(133):505–19 (In Russ.). DOI: 10.34680/2076-8052.2023.4(133).505-519

15. Okhotnikov O.I., Yakovleva M.V., Grigoriev S.N., Pakhomov V.I. Some features of cholestasis in cancer patients during the reduction of liver functional reserves. Russian Journal of Oncology. 2018;23(1):14–9 (In Russ.). DOI: 10.18821/1028-9984-2018-23-1-14-19

16. 16 Leonenko S.N., Voronov A.N., Kapitanova L.E., Fedorets A.V., Abramova K.I. Prevention of complications of endoscopic transpapillary interventions. Tavricheskiy mediko-biologicheskiy vestnik. 2022;25(3):231–4 (In Russ.). DOI: 10.29039/2070-8092-2022-25-3-231-234

17. Sokolov S.V., Sokolov V.P., Bayazitova G.R., Salimgareev I.Z., Loginov M.O., Musharapov D.R., et al. Endobiliary surgery in complex treatment of mechanical jaundice. Bashkortostan Medical Journal. 2018;13(3(75):22–7 (In Russ.).

18. Nartailakov M.A., Nuriakhmetov R.R., Sokolov V.P., Sokolov S.V. Method of external-internal drainage of bile ducts in patients with mechanical jaundice caused by proximal block of bile ducts, without lowering the drainage into the duodenum: Russian Federation patent 2718276. 2020 Apr 01 (In Russ.).

19. Bababeyli E. Minimally invasive surgical interventions under ultrasound and ct control in abdominal abscesses treatment. Surgery. Eastern Europe. 2024;13(4):602–9 (In Russ.). DOI: 10.34883/ PI.2024.13.4.025

20. Ahmed M., Alam J., Hussain S., Aslam M. Prospective randomized comparative study of percutaneous catheter drainage and percutaneous needle aspiration in the treatment of liver abscess. ANZ J Surg. 2021;91(3):E86–90. DOI: 10.1111/ans.16461

21. Gupta A., Thakur N., Chaudhary A.K., Patel U., Arti. Clinical outcomes of liver abscesses in adults: a 10-year experience at a Tertiary care center in Northern India. Cureus. 2024;16(12):e75454. DOI: 10.7759/cureus.75454

22. Amarantov D.G., Pavlova V.N., Barinova A.S. Liver abscesses: modern approaches to diagnosis and treatment. Pirogov Russian Journal of Surgery. 2025;1:93–9 (In Russ.). DOI: 10.17116/hirurgia202501193

23. Garaev M.R., Nartailakov M.A., Loginov M.O., Dorofeev V.D., Giniyatullin B.R., Burkhanov A.K., et al. Endovascular therapy in the combination treatment of widespread purulent peritonitis. Creative surgery and oncology. 2024;14(1):36–41 (In Russ.). DOI: 10.24060/2076-3093-2024-14-1-36-41

24. Savin D.V., Demin D.B., Zheleznov L.M. Acute severe pancreatitis as a surgical problem at the present stage. Medical science and education of Ural. 2022;23(1(109)):132–5 (In Russ.). DOI: 10.36361/1814-8999-2022-23-1-132-135

25. Belokonev V.I., Pushkin S.YU., Khranovsky D.G., Antropov I.V., Katkov S.S., Nikolaev A.V., et al. Pathogenetic rationale for the volume of operation in patients depending on the category of necrotic pancreatitis. Military medicine. 2024;4(73):115–22 (In Russ.). DOI: 10.51922/2074-5044.2024.4.115

26. Levchik E.Yu., Gorodetsky E.B., Kashtanova K.V. Factors associated with increased mortality in patients with unformed lateral duodenal fistulas. The Journal of Emergency Surgery named after I.I. Dzhanelidze. 2024;1:8–14 (In Russ.). DOI: 10.54866/27129632_2024_1_8

27. Yu Lei, Fu Xinya, Zhang Jinpeng, Ren Huajian, Ren Jianan. Management of acute necrotizing pancreatitis with duodenal fistula. World Journal of Surgical Infection. 2024:3(1):32–5. DOI: 10.4103/wjsi.wjsi_5_24

28. Solodky V.A., Kriger A.G., Gorin D.S., Dvukhzhilov M.V., Akhaladze G.G., Goncharov S.V., et al. Pancreaticoduodenectomy — results and prospects (two-center study). Pirogov Russian Journal of Surgery. 2023;5:13–21 (In Russ.). DOI: 10.17116/hirurgia202305113

29. Timerbulatov M.V., Grishina E.E., Aziev M.M., Ziganshin T.M. Robotic reconstruction of bile ducts after iatrogenic injury. Clinical and Experimental Surgery. Petrovsky Journal. 2023;11(2):41–7 (In Russ.). DOI: 10.33029/2308-1198-2023-11-2-41-47

30. Nechay T.V., Panin S.I., Sazhin A.V., Bykov A.V., Kuznetsov A.A., Tyagunov A.E., et al. Comparison of robot-assisted and conventional endoscopic surgeries in the Russian Federation. (A systematic review and meta-analysis). Pirogov Russian Journal of Surgery. 2022;6:88–101 (In Russ.). DOI: 10.17116/hirurgia202206188