Miniinvasive technologies in surgery of gallstone disease complicated by mechanical jaundice

Authors

  • A. S. Nikonenko Zaporizhzhia State Medical University, Ukraine,
  • N.G. Golovko Zaporizhzhia State Medical University, Ukraine,
  • V.А. Grushka Zaporizhzhia State Medical University, Ukraine,
  • А.V. Klimenko Zaporizhzhia State Medical University, Ukraine,
  • E.І. Gaidarzhi Zaporizhzhia State Medical University, Ukraine,
  • D.А. Detsyk Zaporizhzhia State Medical University, Ukraine,
  • I.V. Rusanov Zaporizhzhia State Medical University, Ukraine,
  • G.І. Ohrimenko Zaporizhzhia State Medical University, Ukraine,
  • Т.S. Gavrilenko Zaporizhzhya Regional Clinical Hospital, Ukraine,
  • S.О. Matveyev Zaporizhzhia State Medical University, Ukraine,

DOI:

https://doi.org/10.14739/2310-1237.2013.2.17355

Keywords:

gall-stones disease, mechanical jaundice

Abstract

Entry. Mechanical jaundice is frequent complication of gallstone disease both in urgent and in planned surgery. In the last few years the increase of amount of patients with mechanical jaundice, especially persons of elderly and senile age, is marked and the results of their treatment don’t satisfy surgeons fully. A similar situation cannot remain regardless and requires the search of new ways of decision of this problem.

Research aim. Determination of the most optimal methods of diagnostics and treatment of patients with the gallstone disease complicated by mechanical jaundice and estimation of efficiency of their application.

Materials and research methods. The results of laparoscopic cholecystectomy in 3054 patients with gallstone disease and its complications are analyzed. Experience of surgical treatment of 297 (9,7%) patients with gallstone disease complicated by mechanical jaundice is presented. The most frequent complications were: choledocholithiasis, mechanical jaundice - in 290 (9,5%) patients, combination of choledocholithiasis with stenosis of large duodenal papilla - in 218 (7,1%), stricture of choledoch - in 7 (0,2%). Endoscopic papillosphincterotomy and laparoscopic cholecystectomy was performed for 263 (8,6%) patients with mechanical jaundice.

Research results. On the I stage of treatment of mechanical jaundice in 263 (8,6%) patients with choledocholithiasis and combination of choledocholithiasis with stenosis of large duodenal papilla endoscopic papillosphincterotomy was performed. On the II stage of treatment of patients laparoscopic cholecystectomy was conducted. It was performed on the 2-7 days after endoscopic papillosphincterotomy and verification of the absence of stones in choledoch. The new method of implementation of laparoscopic cholecystectomy the key moment of which is subserosal coagulation of branches of cystic artery is described. The curatively-diagnostic algorithm of treatment of patients with gallstone disease complicated by mechanical jaundice is offered.

Conclusions.

  1. The most informative method in diagnostics of choledocholithiasis, complicated by mechanical jaundice, is endoscopic retrograde cholangiopancreatography (85,4% - 95%).
  2. Endoscopic papillosphincterotomy is the most effective for patients with the diameter of stones in choledoch less than 10 mm. At a diameter more than 10 mm endoscopic papillosphincterotomy in most cases is ineffective. Such patients must undergo the operative intervention by an open method.
  3. Usage of two stage of treatment of the gallstone disease complicated by mechanical jaundice must be priority. We consider the first stage must include combination of endoscopic retrograde cholangiopancreatography and endoscopic papillosphincterotomy, the second stage – laparoscopic cholecystectomy.
  4. The method of gall-bladder devascularisation at laparoscopic cholecystectomy with the use of subserosal coagulation of small branches of cystic artery without selection and ligation of her main branch is the effective method of extrahepatic bilious ducts and main (cystic and hepatic) arteries damage prophylaxis.

References

Донцов И.В. Ятрогенные повреждения желчных протоков / И.В. Донцов // Клінічна хірургія. – 2000. – №10. – С. 31–33.

Лапароскопические технологии и их интеграция в билиарную хирургию / [Малоштан А.В., Бойко В.В., Тищенко А.М., Криворучко И.А.]. – Харьков: СИМ, 2005. – 367 с.

Майстренко Н.А. Холедохолитиаз / Н.А. Майстренко, В.В. Стукалов. – СПб.: ЭЛБИ-СПб, 2000. – 288 с.

Ничитайло М.Е. Повреждения жёлчных протоков при лапароскопической холецистэктомии / М.Е. Ничитайло, А.В. Скумс, И.П. Галочка // Клінічна хірургія. – 2001. – №10. – С. 13–18.

Ничитайло М.Е. Повреждения желчных протоков при холецистэктомии и их последствия / М.Е. Ничитайло, А.В. Скумс. – К.: МАККОМ, 2006. – 344 с.

Осложнения лапароскопической холецистэктомии / Б.К. Шуркалин, А.Г. Кригер, В.А. Горский [и др.] // Вестник хирургии имени И.И. Грекова. – 2001. – Т. 160, №4. – С. 78–83.

Пат. № 37046 Україна. МПК А61В17/00. Спосіб вибору методу деваскуляризації жовчного міхура при лапароскопічній холецистектомії / Губка О.В., Завгородній С.М., Гайдаржі Є.І., Головко М.Г., Децик Д.А., Клименко А.В.; заявл. 15.04.04; опубл. 15.12.04, Бюл. №12.

Султанов С.А. Модифицированная двухэтапная тактика лечения желчнокаменной болезни, осложненной холедохолитиазом / С.А. Султанов, А.А. Архипов // Эндоскопическая хирургия. – 2004. – №4. – С. 26–29.

Федоров И.В. Повреждение желчных протоков при лапароскопической холецистэктомии / И.В. Федоров, Л.Е. Славин, А.Н. Чугунов. – М.: Триада-Х, 2003. – 80 с.

Хирургия печени и желчевыводящих путей / [Шалимов А.А., Шалимов С.А., Ничитайло М.Е., Доманский Б.В.]. – К.: Здоров’я, 1993. – 508 с.

Long-term results and risk factors influencing outcome of major bile duct injuries following cholecystectomy / S.C. Schmidt, J.M. Langrehr, R.E. Hintze [et al.] // Br. J. Surg. – 2005. – Vol. 92. – Р. 76–82.

Management of bile leakage after laparoscopic cholecystectomy based on etiological classification / H.H. Lien, C.S. Huang, M.Y. Shi [et al.] // Surg. Today. – 2004. – Vol. 34 (4). – P. 326–330.

Downloads

Published

2013-09-30

How to Cite

1.
Nikonenko AS, Golovko N, Grushka V, Klimenko А, Gaidarzhi E, Detsyk D, Rusanov I, Ohrimenko G, Gavrilenko Т, Matveyev S. Miniinvasive technologies in surgery of gallstone disease complicated by mechanical jaundice. Pathologia [Internet]. 2013Sep.30 [cited 2024Nov.2];(2). Available from: http://pat.zsmu.edu.ua/article/view/17355

Issue

No. 2 (2013)

Section

Original research

License

Authors who publish with this journal agree to the following terms:

    1. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
Лицензия Creative Commons
    1. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.

  1. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (SeeThe Effect of Open Access).