«Complex» choledocholithiasis in practice of regional centre of endoscopic surgery
Objective. Estimation of rate of various causes of «complex» choledocholithiasis (CL) in practice of regional centre of endoscopic surgery.
Materials and methods. The investigation was conducted on the base of Department of Surgery in Odessa Regional Clinical Hospital in 2019-2021 yrs. Experience of endoscopic operative interventions, performed in 198 patients with clinical signs of CL, was analyzed.
Results. In 45 (22.7%) patients while ultrasonographic investigation a solitary calculus was revealed, while in the others –multiple calculi. Average value of the common biliary duct diameter have constituted (10.5 ± 0.8) mm. In all the patients distal localization of calculi was present, which coexisted in 31 (15.7%) with supraduodenal localization. In 1 woman-patient a valve calculus was revealed, which caused several accidents of biliary colic in anamnesis. Thus, multiple CL was present in majority of the patients. In 53 (26.8%) patients “complex” CL was diagnosed. While analyzing the causes rate of «complex” CL there was established its mostly frequent form (71.7%) occurring after previous multiple attempts of endoscopic interventions. Also frequent forms have appeared in technical complexities while approaching duodenal papilla magna (9.2%), cases of periampullar duodenal diverticulosis (5.8%) and tubular stenosis of common biliary duct (5.0%). Complete endoscopic papillosphincterotomy with the calculi extraction by one séance was performed in 27 (13.6%) patients. In 15 (7.6%) patients the procedure of a one-staged extraction of calculi failed as a consequence of the complications occurrence, presence of multiple big calculi. In these patients repeated seances of endoscopic papillosphincterotomy were done with extraction of calculi, which in 5 (2.5%) patients have demonstrated inefficacy, leading to performance of relithoextraction (up to 3 seances).
Conclusion. Rate of “complex” CL constitutes 26.8%, its mostly frequent cause is previous multiple attempts of local endoscopic interventions. Rate of perioperative morbidity, while doing endoscopic interventions, do not exceed 15%, and mostly frequent complication is an acute pancreatitis. In part of the patients with “complex” CL it is expedient to apply laparoscopic and combined interventions.
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