Analysis of Results of Antergrade and Retrograde Endoscopic Papillotomy after Cholecystectomy

Abstract


Relevance Frequency of occurrence of recurrent and residual choledocholithiasis is about 20%. We assign a special part to antegrade sphincterotomy (ST) in the treatment of intraductal pathology after cholecystectomy. It should be noted that reports about the above mentioned method are scarce (both in national and in foreign literature). The purpose of the study Size the possibilities of antegrade ST, when the pathology of major duodenal papilla (MDP) has been determinated after cholecystectomy. Materials and methods We have studied the results of treatment of obstruction of the extrahepatic bile duct after cholecystectomy in 166 patients. Study group comprised of 60 patients, who have undergone antergrade ST after cholecystectomy. The comparison group consisted of 106 patients who have undergone endoscopic retrograde PST after cholecystectomy. Results and their discussion Choledocholithiasis (43,5%), MDP stenosis (19,2%) and their combination (35,9%) dominate among the causes of intraductal pathology, requiring occasional surgical measures. Recovery after antegrade ST noted by 11,1% more, complications by 4,2% less and by 5,1% less of non-effective interventions were observed in comparison with retrograde ST. Occasional ST after antegrade ST required in 1,7%, which is 13,4% less in comparison with retrograde ST (p<0,001). Antegrade access allows to applicate intraductal interventions to stabilize the bile passage through the usage of transfistule manipulations in comparison with the isolated retrograde access.

Ivanovo State Medical Academy, 8 Sheremet'evskii Ave., Ivanovo, 153012, Russian Federation

Author for correspondence.
Email: author@vestnik-surgery.com
Ph.D., Member editorial council of the journal "Journal of Experimental and Clinical Surgery", Associate Prof., Head of Department of General Surgery, Anesthesiology, Critical Care Medicine and Intensive Care of Ivanovo State Medical Academy of Health Ministry of Russia.

Ivanovo State Medical Academy, 8 Sheremet'evskii Ave., Ivanovo, 153012, Russian Federation

Email: author@vestnik-surgery.com
MD, Head of Department of Surgical Diseases of Ivanovo State Medical Academy of Health Ministry of Russia.

State Clinic of Emergency Medicine, 5 Gor'kogo Str., Vladimir, 600017, Russian Federation

Email: author@vestnik-surgery.com
Head of the X-ray angiosurgery of City Clinical Hospital first aid, Vladimir.

Ivanovo State Medical Academy, 8 Sheremet'evskii Ave., Ivanovo, 153012, Russian Federation

Email: author@vestnik-surgery.com
postgraduate student department of general surgery

  1. Abdullayev E.G., Gusev A.V., Pokrovskiy Ye.ZH., Borovkov I.N., Martinsh CH.T., Guseva Ye.V. Laparoskopicheski assistirovannaya ballonnaya dilatatsiya bol'shogo sosochka dvenadtsatiperstnoy kishki. [Laparoscopically assisted balloon dilatation of the major duodenal papilla]. Endoskopicheskaya khirurgiya, 2008; 4: 9-14.
  2. Andriyenko A.D. Puti uluchsheniya rezul'tatov lecheniya ostrogo kholetsistita, oslozhnennogo kholedokholitiazom, u bol'nykh pozhilogo i starcheskogo vozrasta. [Ways to improve the results of treatment of acute cholecystitis complicated by choledocholithiasis in patients with middle and old age]. Diss. ... Kand. med. nauk. Khabarovsk, 2009; 93.
  3. Klimenko G.A. Kholedokholitiaz. Diagnostika i operativnoye lecheniye.[Choledocholithiasis. Diagnosis and surgical treatment]. M .: Meditsina, 2000; 28.
  4. Maystrenko H.A., Stukalov V.V. Kholedokholitiaz. [Choledocholithiasis].S.-Peterburg: ELBI-SPb, 2000; 48.
  5. Romanov G.A., Lobakov A.I., Dolgova M.B., Sachechelashvili G.L., Denisov B.A., Filizhanko V.N., Agureyev A.I., Yemel'yanova L.N. Kompleksnaya diagnostika i endoskopicheskoye lecheniye retsidivnogo i rezidual'nogo kholedokholitiaza.[Comprehensive diagnosis and endoscopic treatment of recurrent and residual choledocholithiasis]. Annaly khirurgicheskoy gepatologii, 2000; 5: 1: 98-10.
  6. Trukhan D.I., Viktorova I.A. Sovremennyye vozmozhnosti konservativnoy terapii zhelchnokamennoy bolezni. [Modern possibilities of conservative treatment of gallstone disease]. Meditsinskiy vestnik, 2011; 12: 553.
  7. Akopian G., Blitz J., Vander Laan T. Polozhitel'nye storony intraoperacionnoj holangiografii vo vremja laparoskopicheskoj holecistjektomii: javljaetsja li laparoskopicheskoe issledovanie obshhego zhelchnogo protoka neobhodimym? [Positive intraoperative cholangiography during laparoscopic cholecystectomy: is laparoscopic common bile duct exploration necessary?]. Am. Surg., 2005; 71(9): 750-753.
  8. Arvidsson D., Berggren U., Haglund U.Laparoskopicheskoe issledovanie obshhego zhelchnogo protoka [Laparoscopic common bile duct exploration]. Eur. J. Surg., 1998; 164(5): 369-375.
  9. Bove A., Bongarzoni G., Palone G., Di Renzo R.M., Calisesi E.M., Corradetti L., Di Nicola M., Corbellini L. Pochemu sushhestvuet recidiv posle trans puzyrnogo laparoskopicheskogo ochishhenija zhelchnyh protokov? Analiz faktorov riskaю. [Why is there recurrence after transcystic laparoscopic bile duct clearance? Risk factor analysis]. Surg. Endosc., 2009; 23(7): 1470-1475.
  10. Palermo M., Gimenez Dixon M., M., Alvarez F., Ortega A., Bruno M., Tarsitano F.J. Transfistuljarnyj podhod dlja lechenija kamnej sohranjonnyh zhelchnyh protokov. [Transfistular approach for the treatment of retained biliary stones]. Acta Gastroenterol. Latinoam., 2010; 40(3): 239-243.
  11. Roberts-Thomson I.C.Lechenie kamnej v zhelchnyh protokah. [The management of bile duct stones]. Indian J. Gastroenterol., 2004; 23(3): 102-106.
  12. Tang C.N., Tai C.K., Ha J.P., Tsui K.K., Wong D.C., Li M.K. Antegradnoe biliarnoe stentirovanie po sravneniju s drenazhom T-trubki posle laparoskopicheskoj holedohotomii - sravnitel'noe issledovanie gruppy ljudej. [Antegrade biliary stenting versus T-tube drainage after laparoscopic choledochotomy - a comparative cohort study]. Hepatogastroenterology, 2006; 53(69): 220-224.
  13. Tang C.N., Tsui K.K., Yang G.P., Ha J.P., Li M.K. Laparoskopicheskaja issledovanie obshhego zhelchnogo protoka u bol'nyh posle rezekcii zheludka. [Laparoscopic exploration of common bile duct in post-gastrectomy patients]. Hepatogastroenterology, 2008; 55(84): 846-849.

Views

Abstract - 68

PDF (Russian) - 71

PlumX

Dimensions


Copyright (c) 2015 ., ., ., .

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies