Hybrid Interventions in the Treatment of Common Bile Stones

Abstract

In recent years, the incidence of gallstone disease has increased dramatically. Reports on the possibility of a one-stage minimally invasive treatment in the case of complicated cholecystocholedocholithiasis are increasingly found in the literature. Objective: To improve the immediate results of treatment of patients with "difficult” cholecystocholedocholithiasis. Materials and methods: 108 hybrid surgical interventions were performed between 2014 and 2020. Patients with "difficult” choledocholithiasis included with obstructive jaundice complicated by mild cholangitis and also with large single stones of AJP (with a diameter of more than 15 mm), with duodenal diverticula. All interventions were performed in an X-ray room using laparoscopic and endoscopic approach. The average age of the patients was 59.8 years old. Performed 64 laparoscopic cholecystectomy in combination with laparoscopic choledochotomy and lithoextraction. In these cases, the primary suture of the common bile duct was performed with bile duct drainage. 16 patients with duodenal diverticulum underwent a combination of laparoscopy with drainage, cannulation of bile duct and subsequent ERCP and lithoextraction. In 44 cases, simultaneous surgery included laparoscopy and ERCP. Results: The average duration of surgical intervention was 94.2±26.4 minutes, the hospitalization duration was 9.6±4.2 days. In 4 (3.7%) case, residual choledocholithiasis was observed, requiring repeated endoscopic lithoextraction. There were no other complications and deaths. So, hybrid surgical interventions can be used for the simultaneous treatment of patients with complicated cholecystocholedocholithiasis, further accumulation of experience and analysis of the results of these interventions are required.