Laparoscopic choledocholithotomy in the treatment of patients with acute pancreatitis with bile hypertension
DOI:
https://doi.org/10.11603/2414-4533.2018.4.9721Keywords:
acute biliary pancreatitis (ABP), choledocholithiasis, endoscopic retrograde cholangio-pancreatography (ERCP), laparoscopic cholecystectomy, choledochoscopy, duodenumAbstract
The aim of the work: to improve the results of treatment of patients with acute biliary pancreatitis (ABP) with biliary hypertension (BH) by using laparoscopic choledocholithotomy.
Materials and Methods. The study involved 50 patients (6 men and 44 women with an average age of 58.4 years) with moderate severity ABP and BH induced by choledocholithiasis. In all patients, the biliary origin of pancreatitis was diagnosed according to the criteria proposed by the Dutch Pancreatitis Research Group. Hospitalization of patients in the hospital took place from 2 to 48 hours from the onset of the disease. Most patients (60 %) were hospitalized not later than 24 hours after the onset of the disease. Concomitant illnesses were found in 36 (72 %) patients: coronary heart disease – in 28 (56 %), hypertensive illness of different severity – in 27 (54 %), chronic hepatitis – in 15 (30 %), increase in body mass index, which corresponded to obesity – in 1 (2 %), diabetes – in 2 (4%), anemia – in 1 (2 %). The personalized algorithm of surgical treatment was applied, which allowed to choose a method of elimination of biliary hypertension in the first 12–72 h after the occurrence of a pain attack.
Results and Discussion. In the first 12–72 hours of the disease performed: ERCP (n = 33), laparoscopic cholecystectomy, choledochoscopy and lioextraction with external drainage of extrahepatic bile ducts (n = 13), percutaneous peritoneal puncture of the biliary tract (n = 7). Laparoscopic lioextraction was used in 26 % of patients, which made it possible to simultaneously eliminate the cause of BH and perform cholecystectomy. Mortality was 2 % (1 patient). The average length of stay in a hospital is 12.46 days.
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