Вестник хирургии имени И.И. Грекова (Feb 2024)
Minimally invasive endobiliary interventions in difficult cases of choledocholithiasis for endoscopic guidance
Abstract
The OBJECTIVE was to estimate the effectiveness of endobiliary interventions performed in the antegrade version in the correction of biliary tract pathology in patients who underwent surgery on the biliary tract, upper part of the gastrointestinal tract and after unsuccessful endoscopic treatment.METHODS AND MATERIAL. Treatment results of 63 patients with biliary tract pathology using antegrade endobiliary interventions in complicated cases for endoscopic support were analyzed. In 44 (70.0 %) cases, the PTBD was carried out as the first stage. Correction of biliary duct pathology in one stage was carried out in 19 (30.0 %) cases. At the second stage, the antegrade correction of biliary tract pathology was carried out in 43 (97.7 %) patients. In addition, lithoextraction was carried out in 5 (11.6 %) cases, lithotripsy in 4 (32.5 %) cases, laser vaporization of stricture in 2 (4.6 %) cases. The conversion to laparotomy was required in 1 (2.3 %) case. Cholecystectomy at the third stage was performed on 36 (57.1 %) patients.RESULTS. Specific problems were noted in 8 (12.7 %) patients. In the postdecompression phase in mechanical jaundice, «rapid» decompression syndrome developed in 4 (8.5 %) cases. Amylasuria, increased liver function test results appeared in 5 cases. Fluid accumulation under the right lobe of the liver was observed at the third stage after cholecystectomy in 1 patient. Signs of cholangitis after endobiliary interventions were in 3 patients. Failure of antegrade resolution of biliary tract pathology was reported in 1 case due to device failure. Postoperative lethality was 1.6 %.CONCLUSION. In complicated for retrograde resolution of the biliary tract pathology under the endoscopic navigation, the antegrade method under the radial navigation is quite effective method of the biliary tract pathology correction.
