Contemporary aspects of diagnosis and treatment of choledocholithiasis

Abstract

Introduction: Over the last decades the incidence of gallstones points out a major ascension. As a result we notice an increase of choledocholithiasis level, often being Associated with jaundice and angiocholitis. Optimal diagnosis and treatment evaluation, addressed to patients with choledocholithiasis on the basis and experience of Surgery Department No.2. Material and methods: 41 patients with choledocholithiasis were examined, who were treated in the hepato-biliary-pancreatic department of the Republican Clinical Hospital during 2014-2015 years. Diagnostic algorithm included several consecutive steps: I step - biochemical testing, sonographic examination; II stage - biliary tree direct contrast running the endoscopic retrograde cholangiopancreatography ERCP. In cases of difficulty in diagnosis magnetic resonance cholangiopancreatography (MRCP) or computed tomography was made. Discussion results: ERCP was confirmed to be an optimal method both in topic diagnosis establishment and in decompression of biliary tree realization for a preoperative preparation. So in 30cases (73,17%) the full endoscopic extraction of stones with final recovery of patients was possible. In 4 cases (9,75%) the method allowed the CBP drainage over obstacle through a stenting with 7 Fr stent preparing patients for the second stage of the treatment of these 3 patients (7,31%) required choledochotomy with classical litextraction. And one patient (2,43%) had a megalocholedoch with multiple stones, but the situation was resolved by transection of choledoch with choledochojejunostomy on Roux loop. Postoperative complications were recorded in 3 patients being motivated by wound suppuration treated conservatively. Fatal outcomes in the study group were none. Conclusions: Minimally invasive endoscopic technologies allow final settlement of choledocholithiasis with stones up to 15 mm, but for exceeded cases there is a stage of decompression and drainage of cholangitis, a preparation for surgical interventions calmly. For an up to 20 mm choledoch in the absence of duodenostasis or distal strictures choledocholithotomia is done. Megalocholedoch is an indication for choledochojejunostomy on Roux loop.