Optimization of surgical approach for the treatment of gallstone disease complicated by obstructive jaundice

Abstract

An elevated morbidity rate due to gallstone disease (GSD) is accompanied by a 35% increase in the frequency of complication occurrence. Surgical treatment of GSD complicated by obstructive jaundice (OJ) is an urgent problem due to a relatively high percentage of complications and lethal outcomes. To improve the surgical treatment outcomes of patients with GSD complicated by OJ by introducing a differentiated approach to the choice of surgical intervention tactics. The surgical treatment outcomes of 384 patients operated for cholelithiasis complicated by mechanical jaundice in the period from 2016 to 2020 were analysed in this work. The performed study demonstrates that minimally invasive interventions and their sequence in this category of patients should be defined based on the severity of OJ. Minimally invasive surgery positively affects LPO indices and significantly decreases MDA (1.2-fold in subgroups with mild and moderate OJ (p < 0.0001), 1.4-fold (p < 0.0001) - with severe OJ). Compared to conventional surgery, catalase activity increased 1.1-fold in the subgroups with mild to moderate OJ (p < 0.0001) and 1.3-fold in those with severe OJ (p < 0.0001). The illness severity-differentiated surgical approach for GSD complicated by OJ allows the optimal minimally invasive surgical intervention to be chosen in patients with this pathology.