Antegrade choledochoscopy in laparoscopic cholecystectomy is a method of diagnosis and treatment of papillostenosis

Abstract

In the last 30-40 years, there has been a trend in the incidence of cholelithiasis, which, in turn, is often complicated by the development of papillostenosis of various degrees requiring surgical correction. Currently, it is widely used in the diagnosis and treatment of papillostenosis: retrograde choledochopancreatography and endoscopic papillosphincterotomy, but these types of surgical correction of the pathology of large duodenal papilla have a number of disadvantages. In this connection, antegrade choledochoscopy with subsequent augmentation is an option for the diagnosis and correction of papillostenosis narrowing.Aim: of the study is to study domestic and foreign literature on methods of diagnosis and treatment of papillostenosis. To conduct a comparative analysis of the instrumental methods presented in practice, to evaluate the effectiveness of endoscopic antegrade choledochoscopy in papillostenosis.Materials and methods. 31 case histories of a patient who was hospitalized in the Department of Surgery of the Hospital No. 18 from 2013 to 2022 with papilla stenosis complicated by mechanical jaundice, who underwent followed by papillaa ugmentation, were analyzed. A narrowing of the lumen of the papilla of less than 2 mm was considered an indication for antegrade choledochoscopy with buging. The postoperative period in 100 % of patients proceeded without peculiarities. The number of bed-days of hospital stay is 4-6 days, discharged with improvement.Of 100 % of patients - 3.2 % (1 patient) – had a history of papilla restenosis after undergoing laparoscopic cholecystectomy, antegrade choledoscopy and augmentation (4.5 years after the first intervention), he underwent retrograde choledochopancreatography and endoscopic papillosphincterotomy.Conclusion. As presented for 10 years of experience in the use of antegrade choledochoscopy with the bougie of papilla in laparoscopic cholecystectomy, this technique for the diagnosis and treatment of papillostenosis has a large 5-year effectiveness (96.8 %), sensitivity, both due to the optical component of diagnosis and due to the objective component – bougie. In this connection, this method can be used in the practice of a surgeon.

Keywords

• surgery
• papillostenosis
• augmentation
• choledochoscopy