Zaporožskij Medicinskij Žurnal (Jul 2018)
Predictors of hyperamylasemia in patients with cholecystolithiasis after laparoscopic cholecystolithotomy with intraoperative dosed endoscopic papillotomy
Abstract
The purpose of the work is to improve the early and long-term results of patients with cholecystolithiasis treatment by supplementing cholecystolithotomy with one-stage intraoperative dosed endoscopic papillosphincterotomy (EPST) and predictors of increased risk of transient hyperamylasemia after EPST identification. Material and methods. 33 patients with cholecytholithiasis were involved in the study, the average age was 46.82 ± 13.02 years, women 27 (82 %), body mass index 28.56 ± 5.85 kg/m2. We studied intraoperative, early postoperative complications and long-term results. The follow-up period of patients with cholecystolithiasis after cholecystolithotomy with intraoperative dosed endoscopic papillotomy was 1424 days (3.9 years), median follow-up – 467 days. The odds ratio was calculated using logistic regression analysis. Results. Intraoperative and early postoperative complications were not observed. During the endoscopic papillotomy and in the early postoperative period no serious complications (duodenal perforations, bleeding, pancreatitis (pancreatic necrosis)) were observed. Transient hyperamylasemia occurred in 4 (12.12 %) out of the 33 patients with choledocholithiasis who were performed laparoscopic cholecystolithotomy with intraoperative papillotomy in the first day after surgery. According to the logistic regression, the choledochus ascending diameter increase more than4.2 mm (HS = 2.31; 95% CI 1.02–6.11; P = 0.0483) is associated with transient amylasemia. One case of acute non-calculous cholecystitis requiring the surgical intervention (laparoscopic cholecystectomy) was registered during 3.9 years of follow-up. Recurrence of cholecystocholedocholithiasis and major duodenal papilla stenosis occurred in no case. Conclusions. Laparoscopic cholecystolithotomy supplemented with one-stage intraoperative dosed endoscopic papillotomy performed according to absolute indications, are safe and highly effective surgical intervention, which allows preserving the gall bladder, restoring its motor-evacuator and concentration functions, and preventing recurrence of cholecystocholedocholithiasis by restoring bile outflow to the duodenum. Transient hyperamylasemia occurred in the first day after operation in 12.12 % (4/33) patients with cholecystolithiasis, who were performed laparoscopic cholecystolithotomy with intraoperative endoscopic papillotomy. The predictor of transient hyperamylasemia after cholecystolithotomy with intraoperative dosed endoscopic papillotomy in patients with cholecystolithiasis is the ascending choledochus diameter increase more than4.2 mm (VS = 2.31; 95 % CI 1.02–6.11; P = 0.0483).
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