Minimally-invasive and endovideosurgical technologies in diagnosis and treatment of choledocholithiasis.

Abstract

. The paper presents the results of the use of minimally-invasive methods in the diagnosis and treatment of choledocholithiasis. The results of treatment of 595 patients aged from 24 to 92 years with the diagnosis of choledocholithiasis were evaluated. In 552 (93,0%) patients, clinical ma­nifestations of mechanical icterus were noted. In 508 (85,3%) patients, choledocholithiasis was combined with the presence of gallstones, in 15 (2,5%) cases – with calculous cholecystitis, in 69 (11,6%) cases - choledocholithiasis was residual. For the diagnosis of choledocholithiasis, ultrasound of the abdominal cavity, computed tomography, endoscopic retrograde cholangiopancreatogy, percutaneous fistulocholangiography, intraoperative cholangiography or cholangiography were used. Surgical treatment included both mini-invasive interventions and traditional operations. 227 (38,1%) patients underwent endoscopic papillosphincterotomy, which was effective in a size of concrement up to 7 mm in 83,7%. The percutaneous drainage of the bille ducts was performed in 88 (14,7%) patients, the efficacy was achieved in 82,9%. 313 (52,6%) patients subsequently underwent the second stage of surgical treatment of choledocholithiasis by laparoscopy – 263 (84,0%) and laparotomy – 50 (16,0%) with cholecystectomy with choledocholithoextraction and subsequent external or internal drainage of choledochus. Comparison of different methods of investigation showed that none of the diagnostic techniques had 100% of accuracy and informative value. The efficacy of transpapillary manipulation directly depended on the size of the stones.