ALGORITHM OF ENDOVIDEOSCOPIC TREATMENT CHOLELITHIASIS COMPLICATED BY CHOLEDOCHOLITHIASIS

Introduction: We can’t cure choledocholithiasis endoscopically often and we have problem with choice of treatment - laparoscopic or laparotomic choledo-chotomy. Goal is development a treatment algorithm and analysis of treatment patients with choledocholithiasis.Materials and methods: patients with choledocholithiasis and/or with stenotic duodenal papillitis (weren’t treatment endoscopic) were separated into two statistically homogeneous groups. Main group (n=47) - patients operated laparoscopically and control group (n=50) patients operated laparatomicically. Results: In main group was done suproduodenal choledochotomy and sanitation of choledochus. In 29 cases was done choledochoscopy with lithoextrac- tion by instruments. For 7 patients was done antegrade papillosphincterotomy. After rebuildability hepatitis was done choledochography with drainage by Holsted-Pikovsky or was done choledochoduodenostomy.In main group operation was continued about 101,26±19,81 min, In control group about 96,8±14,25 min. Level of pain by ten-point scale surgery after 6 hours in main group was 2,51±2,13, in control group was 3,04±1,85 (p<0,05). Narcotic analgesics received 2 patients in main group and 41 patients of control group. At the first day in main group dose of narcotic analgesic was 0,45±0,93 mg and in control group was 8,11±4,62 mg. Slight postoperative com- plications (classification by Clavien-Dindo) noticed at 17 patients of main group and at 24 patients of control group. Complications of the second degree noticed at 3 patients of control group. Complications of the third a (3 a) degree noticed at 1 patient of main group. In each group noticed 1 case insolvency of holedohoduodenoanastomosis which were operated successfully again.Conclusion: The proposed algorithm showed efficiency and safety. Laparoscopic surgery at patients with choledocholithiasis and/or with stenotic duodenal papillitis are surgery of choice.

choledocholithiasis, algorithm of treatment, laparoscopic choledocholithotomy

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