Postcholecystectomic syndrome. An interventional endoscopy, advantages in the treatment of the residual choledocholithiasis

Abstract

Introdution: Over the last decades the morbidity of choledocholithiasis increases therefore also increases the number of surgical interventions such as cholecystectomy and the interventions on the biliary tract, mostly connected with a choledocholithiasis. A number of recurrent stones in the biliary tract increases, which stimulate the development of medicine and further improvement of miniinvasive interventions to avoid those negative effects, which are caused by open methods. Purpose and Objectives: To improve the results of treatment for the residual choledocholithiasis and to compare miniinvasive and open methods of surgery. Materials and methods: At the hospital 204 patients with the obstructive jaundice non-neoplastic etiology have been treated. We have taken and analyzed 60 cases of PCES, including men, which were 30 (50%), and women, which also were 30 (50%). Interventional endoscopy was made for 30 (50%) patients (the study group); 30 (50%) patients were subjected to open methods (the control group). Patients in the study group were treated with the endoscopic retrograde cholangiopancreatography (ERCP), which includes endoscopic papilosphyncterotomy (EPST), litoextraction (LE), papilosphyncteroplastic (PSP), endoscopic revision and sanitation+balloon dilatation. To the patients in the control group was made an open cholecystectomy (CE) with choledochoduodenoanactomosis (CDA), CDA and reconstructive surgery: a transformation of CDA to choledochojejunoanastomosis (CJA). All patients had general medical examination, ultrasound of the abdomen, computed tomography. Endoscopic interventions were carried out with the FUJ1NONED - 250XT5 apparatus, papilotom «Olympus» and «Wilson Cook», Dormia basket, mechanical Lithotripters «Olympus», «Soring» machine was used for the tom, the cutting and coagulation mode. Results: In the study group there were 2 cases of postoperative complications and in the control - 8 cases, which in the percentage for the study group is 6.66 %, and for the control - 30%. While conducting this analysis was highlighted the following symptoms: bleeding, pancreatitis, and cholangitis. In the study group were recorded one case of bleeding (3.33 %) and cholangitis (3.33 %). For the comparison, in the control group were recorded 3 bleeding (10.0 %), 4 pancreatitis (13.33 %) and 2 cholangitis (6.67 %).In the study group hospital patients stayed for the 3 ± 1 bed-day, in the control for the 13 ± 2 bed-days. Duration of endoscopic surgery on average lasts 27 ± 15 min., and the open surgery lasts 90 ± 15 min. There was no lethal outcome in both study and control groups. Conclusions: Miniinvasive interventions have following advantages over the open surgical intervention: (1) Much shorter operation duration and less traumatism. (2) Reduced the number of complications in the early postoperative period. (3) Reduced the length of patient staying in the hospital.