Rationale for the timing of laparoscopic cholecystectomy on the basis of the rate of biliary tract decompression in obstructive jaundice caused by cholecystocholedocholithiasis
DOI:
https://doi.org/10.11603/2414-4533.2019.4.10714Keywords:
laparoscopic cholecystectomy, decompression, bile ducts, jaundice, choledocholithiasisAbstract
The aim of the work: to justify the optimal timing of laparoscopic cholecystectomy after previous endoscopic transpapillary intervention in patients with perturbed jaundice caused by cholecystocholedocholithiasis, by determining the rate of bile duct decompression and the dynamics of recovery of functional indicators of the liver.
Materials and Methods. In 59 (33.34 %) patients, a two-stage technique (transbiliary endoscopic drainage + laparoscopic cholecystectomy) was tested, with optimal timing of radical surgery based on bilirubin dynamics and rate of decompression after endoscopic intervention.
Results and Discussion. The rate of jaundice response during transpapillary biliary decompression at mild jaundice at 1–3 days after surgery was moderate (B = 14.3). Whereas on day 4–6, the response rate was protracted (B = 9.62). The study in the group of patients with moderate severity of jaundice showed that the rate of response of jaundice to transpapillary decompression in patients at 1–3 days was (B = 19.), which corresponds to the fast pace, and at 4–6 days after decompression, the transformation of fast temp to moderate (B = 11.14). In patients with severe jaundice, a prolonged rate of 1–3 days after surgery was observed (B = 9.66), whereas at 4–6 days after decompression, the response rate of jaundice was transformed into rapid (B = 20.66). In patients with mild jaundice with a moderate – prolonged rate of decompression, it is advisable to perform the second stage of surgery in the first three days after the decompression period; at an average degree and at a moderate rate of decompression – for 4–6 days after the previous operation; at a severe degree and at a rapid rate of 4–6 days after decompression – from 14 days after the decompression period or treatment ends with the first stage.
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