Evaluation of the influence of methods of sanitation of the common bile duct on the course of the postoperative period of endoscopic papillosphincterotomy

Abstract

Gallstone disease continues to occupy a leading position in terms of the number of surgical interventions in modern emergency surgery. The purpose of our study is to determine the risks of developing post-manipulation pancreatitis depending on the method of sanitation of the choledochus, to determine the dynamics of regression of hyperamylasemia and hyperbilirubinemia in patients after endoscopic papillosphincterotomy (EPST), to assess long-term results—the frequency of repeated hospitalizations and the need to perform surgical interventions for restenosis of the papilla. Materials and methods : a prospective analysis of 60 clinical cases of patients after EPST was performed. Patients were divided into 2 groups depending on the method of sanation of the common choledochus. The frequency of development of an increase in the level of blood amylase and bilirubin and the timing of regression of these indicators were assessed. An analysis was also made of repeated cases of hospitalizations and the need for interventions on the papilla. Results : the development of hyperamylasemia in the group of revision of the choledochus occurred in 23% of cases, in the group without mechanical sanitation — in 13%. Hyperbilirubinemia in the immediate postoperative period developed in 27 and 23% of cases, respectively. The terms of regression of elevated biochemical parameters were higher in the group of patients with a mechanical method of sanation of the common choledochus. Conclusion : mechanical methods of sanation of the common choledochus can increase the incidence of post-manipulation complications after EPST and increase the recovery time for normal values of biochemical parameters. To assess the longterm results of the development of papillary restonosis after EPST, it is necessary to form larger groups of patients with the possibility of conducting a multicenter study.