Evaluation of the feasibility of using a one-stage strategy for the treatment of choledocholithiasis and cholecystolithiasis by performing simultaneous laparoscopic interventions with a two-stage strategy

Abstract

The aim of the work: to study the complications associated with a one-stage strategy for the treatment of choledocholithiasis and cholecystolithiasis, which involves simultaneous cholecystectomy and choledocholithotomy with intraoperative cholangiography using our own developed method of setting laparoscopic ports. Evaluation of the feasibility of using each of the methods.

Materials and Methods. In the period from 2015 to 2019, 118 patients with a combination of choledocholithiasis and cholecystolithiasis were treated. All patients underwent surgical treatment using the developed technique of simultaneous operations. The comparison of treatment duration and safety profile of the developed method was performed with that for the two-stage method using endoscopic retrograde cholangiopancreatography. The control points of the studies were the length of hospital stay and the frequency of complications. Data on these indicators are obtained from the publications of our colleagues.

Results and Discussion. The duration of treatment in the study group was 4 bed-days, which is less than the duration of treatment in the experiments of our colleagues (at least 6 days). The level of complications when using the one-stage method with own technique was 0.85 %, which is significantly less than the total level of local and general complications typical for ERCP (6.85 %). If ERCP is recurrent (12–23 %), the level of complications increases to 19.35 %, which in our opinion is an unacceptable risk. Acute pancreatitis, cholangitis, intestinal perforation, and septic conditions, including those associated with resistant microflora, are also uncommon complications for one-stage method. The use of a non-invasive method (MRCP) for the diagnosis of choledocholithiasis is a priority over invasive and dangerous ERCP.