Abstract:

The causes of obstructive jaundice can be categorized into benign and malignant etiologies. (1) Benign obstructive jaundice, such as choledocholithiasis and mucobilia, necessitates the removal of the underlying causes, with a focus on preventing iatrogenic bile duct injury. Over the past two decades, we have employed innovative techniques in laparoscopic cholecystectomy, including the macroscopic methods of ductal identification through the gallbladder infundibulum localization by an imaginary clock and the concept of gallbladder disabled technique. On a microscopic level, we have utilized a classification system of 11 categories and 33 types for gallbladder ducts and 8 subtypes for gallbladder arteries, effectively preventing bile duct injuries and postoperative complications. (2) Malignant obstructive jaundice, especially when originating from high-level obstructions caused by hilar cholangiocarcinoma, has shown enhanced surgical success rates when employing 3D laparoscopy in conjunction with hepaticojejunostomy. For low-level obstructions, the implementation of tertiary prevention measures during pancreaticoduodenectomy demonstrates efficacy in the reduction of complications, such as pancreatic leakage. In cases where surgical resection is not feasible, palliative biliary drainage, either internal or external, can alleviate jaundice and preserve organ function. This article summarizes the experiences and outcomes of applying novel clinical techniques in the management of obstructive jaundice over the past two decades in our single-center institution.

Key words: Obstructive Jaundice, Cholelithiasis, Iatrogenic Bile Duct Injury, Biliary Tract Cancer, Pancreatic Cancer, Gallbladder Cancer