Surgical treatment of patients with mechanical jaundice syndrome caused by choledocholithiasis
https://doi.org/10.20340/vmi-rvz.2023.3.CLIN.4
Abstract
Treatment of patients with mechanical jaundice remains an urgent problem of modern surgery. Approximately in a half of patients the cause of this syndrome is the presence of concrements in the common bile duct. Nowadays there are various variants of choledocholithiasis surgical treatment – open surgery on bile ducts and various variants of endoscopic interventions.
Objective: to determine indications for open variants of surgical treatment of the syndrome of mechanical jaundice caused by choledocholithiasis.
Material and methods. The work is based on the retrospective analysis of the treatment results of 78 patients with the syndrome of the mechanical jaundice caused by choledocholithiasis. Patients were divided into two groups depending on the way of the mechanical jaundice elimination. The first group included 20 patients who underwent open surgery, and the second group consisted of 58 patients after endoscopic interventions.
Results. In the 1st group 4 patients died out of 20 patients, the lethality rate was 20%. In Group II 2 of 58 patients died, the lethality was 3%. The difference in the lethality indexes between the groups turned out to be statistically significant (p = 0,028).
Conclusion. Open surgery is indicated in patients with contraindications to pneumoperitoneum application due to the second half of pregnancy or concomitant pathology of the cardiovascular and/or respiratory systems, in unsuccessful attempts to perform endoscopic intervention, and also in concomitant pancreatitis.
About the Authors
V. K. Koryttsev
Samara State Medical University
Russian Federation
Russian Federation
Vladimir K. Koryttsev, Dr. Sci. (Med.), Associate Professor, Professor of the Department of Faculty Surgery
89 Chapaevskaya str., Samara, 443099
A. M. Krasnoslobodtsev
Samara State Medical University;
N.I. Pirogov City Clinical Hospital No. 1
Russian Federation
Russian Federation
Andrey M. Krasnoslobodtsev, Surgeon of the Surgical Department No. 6; candidate of the degree of Cand. Sci. (Med.), attached to the Department of Faculty Surgery
80 Polevaya str., Samara, 443096;
89 Chapaevskaya str., Samara, 443099.
E. V. Frolova
Samara State Medical University
Russian Federation
Russian Federation
Frolova Elena Vladimirovna, Dr. Sci. (Med.), Associate Professor, Associate Professor of the Department of Faculty Surgery
89 Chapaevskaya str., Samara, 443099
S. V. Dergal
Samara State Medical University;
Samara City Clinical Hospital No. 8
Russian Federation
Russian Federation
Sergey V. Dergal, Cand. Sci. (Med.), Assistant of the Department of Faculty Surgery; Chief Physician
89 Chapaevskaya str., Samara, 443099;
169 Mirnaya str., Samara, 443035
References
1. Gabriel S.A., Dynko V.Yu., Durleshter V.M. et al. Retrograde endoscopic interventions for mechanical jaundice. Bulletin of Surgical Gastroenterology. 2016;3:52. (In Russ).
2. Bekheit M., Smith R., Ramsay G. et al. Meta-analysis of laparoscopic transcystic versus transcholedochal common bile duct exploration for choledocholithiasis. BJS Open. 2019;3:249.
3. Navaratne Lalin, Martinez Isla Alberto Transductal versus transcystic laparoscopic common bile duct exploration: an institutional review of over four hundred cases. Surgical Endoscopy. 2021;35:437–438.
4. Khadjibaev F.A., Tilemisov S.O., Hashimov M.A. and others. Antegrade and retrograde cholangiography in the diagnosis of mechanical jaundice. Bulletin of Surgical Gastroenterology. 2016;3:76–76. (In Russ).
5. Syrén Е., Eriksson S., Enochsson L. et al. Risk factors for pancreatitis following endoscopic retrograde cholangiopancreatography. BJS Open. 2019;3:488–489.
6. Korolev M.P., Fedotov L.E., Avanesyan R.G., etc. Retroduodenal perforation as a complication of endoscopic interventions in mechanical jaundice. Bulletin of Surgery named after I.I. Grekov. 2017;176(4):68–70. (In Russ).
7. Shapovalyants S.G., Fedorov E.D., Freidovich D.A., etc. Modern therapeutic and diagnostic approaches for complex forms of choledocholithiasis. Moscow Surgical Journal. 2018;3:144–144. (In Russ).
8. Biktagirov Yu.I., Shteyner M.L., Korymasov E.A., Krivoshchekov E.P., Rakhimov B.M. Endoscopic transpapillary stenting of the ductus hepaticocholedochus in patients with mechanical jaundice associated with tumors. Bulletin of the Medical Institute "REAVIZ" (Rehabilitation, Doctor and Health). 2020;(2):57-61. (In Russ).
9. Durleshter V.M., Gabriel S.A., Guchetl A.Ya. et al. Endoscopic transpapillary interventions in the treatment of patients with biliary hypertension of various genesis. Bulletin of Surgery named after I.I. Grekov. 2017;176(6):60–65. (In Russ).
Supplementary files
Review
For citations:
Koryttsev V.K., Krasnoslobodtsev A.M., Frolova E.V., Dergal S.V. Surgical treatment of patients with mechanical jaundice syndrome caused by choledocholithiasis. Bulletin of the Medical Institute "REAVIZ" (REHABILITATION, DOCTOR AND HEALTH). 2023;13(3):54-57. (In Russ.) https://doi.org/10.20340/vmi-rvz.2023.3.CLIN.4
Views:
349
Email this article 