Choledocholithiasis: modern possibilities of diagnosis and surgical treatment

Abstract

Studies have examined various approaches in the diagnosis and surgical treatment of patients with cholelithiasis complicated by choledocholithiasis, evaluated the possibilities of using modern methods of treating the disease, and proposed a strategy to prevent the abandonment of bile duct concretions. The relevance of this problem is related to the variety of diagnostic and surgical treatment methods of choledocholithiasis, high disease frequency, and nonexistence of a unified approach to the examination and choice of surgical treatment in patients with cholelithiasis complicated by choledocholithiasis. These issues indicate the need to study this problem and identify optimal approaches to examination and treatment, including modern minimally invasive methods of treatment. The analysis of the diagnostic value of various examination methods and surgical outcomes was based on the experience of treating 154 patients with cholelithiasis complicated by choledocholithiasis in the clinic of the S.P. Fedorov Faculty of Surgery of the S.M. Kirov Military Medical Academy. An algorithm for examining patients with cholelithiasis was formed based on the diagnostic value of various research methods, which allows timely detection of choledocholithiasis. The results of various approaches to the surgical treatment of patients with cholelithiasis complicated by choledocholithiasis were analyzed. In the absence of general somatic contraindications and the availability of technical capabilities, a one-stage approach to surgical treatment was suggested. Moreover, an individual approach is necessary for the treatment of patients with cholelithiasis complicated by choledocholithiasis, taking into account the nature of the disease course and its complications, comorbid status of the patient, and technical capabilities of a particular hospital. The sequence and timing of operations with a two-stage approach should be determined, taking into account the acute conditions and comorbidities of the patient. The use of modern minimally invasive technologies, such as transpapillary and trans-bubble choledochoscopy, dosed papillotomy, and rendezvous technique for the cannulation of the large papilla of the duodenum, allows us to improve the results of surgical treatment and reduce the risk of complications. Transpapillary and trans-bubble nanoelectroimpulse lithotripsy are alternative methods of resolving major choledocholithiasis in both one-stage and two-stage treatment.