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CNAA / Theses / 2020 / July /

Clinical-functional efficacy of surgical treatment of benign biliary strictures

Author: Ferdohleb Alexandru
Degree:doctor habilitat of medicine
Speciality: 14.00.27 - Surgery
Scientific adviser: Vladimir Hotineanu
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Institution: Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova


The thesis was presented on the 8 July, 2020
Approved by NCAA on the 30 October, 2020


Adobe PDF document1.50 Mb / in romanian


CZU 616.367-007.271-089(043.2)

Adobe PDF document 10.00 Mb / in romanian
269 pages


benign biliary stricture, angiocholitis, hepaticojejunoanastomosis, bihepaticojejunohanastomosis, choledocojejunoanastomosis, GSRS, SF-36, quality of life


Structure of the thesis: introduction, 6 chapters, general conclusions, practical recommendations, bibliography from 293 references, 211 basic text, 83 tables and 49 figures. The obtained results were published in 67 scientific papers.

The aim of the research. The complex research of the surgical treatment in patients with benign biliary strictures, with the elaboration of the optimal surgical techniques in order to make the immediate and delayed results more efficient in order to ensure a long-lasting improvement of the quality of life.

Objectives of the research: (1) complex assessment of the surgical treatment and it’s results depending on the location level of the lesion of main bile duct and on clinical-evolutive dynamics of patients with BBS; (2) competitiv analysis of therapeutical results obtained through reconstructive surgery in patients with BDS and phasing of the researched subject depending on the lesion type; (3) the study of the factors determining the immediate and remote results of surgical treatment, based on the medical-individual characteristics of patients with BBS; (4) complex analysis of study cases in terms of improving the quality of life and gastrointestinal functionality in the context of reconstructive surgical treatment of BBS; (5) evaluation of the results of treatment in terms of providing the possibility of modeling and developing standardized criteria for controlling depending on the type and level of the biliodigestive anastomosis; (6) development of a screening protocol to track the evolution of the reconstructive surgical treatment.

The novelty and scientific originality is based on the first realization for the Republic of Moldova of a complex study in the field of surgical treatment of benign biliary strictures and the argumentation of new scientific concepts regarding the efficiency of the surgical treatment, the quality of life of these patients and the surgical management of the remote complications.

The important scientifical-applicative problem which was solved. We validated the deductive diagnostic algorithm. The medical-surgical protocol of the preoperative and of intra- and postoperative behaviour of the patient with BBS was developed and implemented. We took advantage the results which offered us the possibility to model the standardized control criteria according to the therapeutic protocols depending on the type and level of the biliodigestive anastomosis. We created a system for evaluating the tactical and surgical methods of biliary reconstruction and HJA formation, based on which a tactical-surgical algorithm was formed. The application of the techniques for highlighting and preparing the biliary stump in case of high strictures type III and IV was argued. We demonstrated the clinical and functional efficacy of the innovative hepaticojejunoanastomoses on the Roux loop, analyzing the immediate and remote complications, and the quality of life.

Theoretical significance, applicative value and implementation of scientific results. The present research argued and completes the contemporary scientific concepts regarding the major importance of reconstructive interventions addressed to patients with benign biliary strictures, by choosing the optimal surgical option and the appropriate surgical tactic for each case. The obtained results scientifically substantiated the main directions for improving the conduct of patients with BBS.

Implementation of scientific results. The results of the study were approved as scientific value and implemented in the activity of Hepato-bilio-pancreatic Surgery department, Hepatology and Abdominal-Visceral Department of MSPI Republican Clinical Hospital, didactic activity of Chairs of Surgery nr. 2 of Nicolae Testemițanu SMPhU. There were registered 5 acts of results' implementation.