Antegrade approach for cholangiolithiasis complicated by mechanical jaundice

Prazdnikov, E. N.; Baranov, G A; Zinatulin, Dmitry Ravilyevich; Umyarov, R Kh; Шевченко, В. П.; Nikolayev, N M

doi:10.17116/hirurgia2018121-25

Cited by 9 publications

(2 citation statements)

References 7 publications

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“…Decompression interventions in the biliary tract are often performed against an unfavorable background due to the long disease course, and the existing methods of correction of hepatic metabolic disorders do not comprehensively consider all the pathophysiological mechanisms that lead to the development of liver failure [ 19 ]. In this regard, a central objective for the treatment of OJ is a pathogenetically supported method to restore the functional activity of liver tissue, based on the preservation of its metabolism and general correction of endotoxemia detoxification [ 20 , 21 , 22 , 23 , 24 , 25 ]. Therefore, greater attention has been paid to the study of pathophysiological processes that occur not only in the liver but also in general processes, that affect other organs and systems in individuals with OJ, which allows for the determination of optimal management of patients in the perioperative period and the practical implementation of personalized medicine.…”

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confidence: 99%

Comparative Study of the Results of Operations in Patients with Tumor and Non-Tumor Obstructive Jaundice Who Received and Did Not Receive Antioxidant Therapy for the Correction of Endotoxemia, Glycolysis, and Oxidative Stress

et al. 2022

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Purpose: To compare the results of surgical treatment and changes in biomarkers of cholestasis, endotoxicosis, cytolysis, lipid peroxidation, glycolysis disorders, and inflammation in patients with benign and malignant obstructive jaundice (OJ) in patients receiving and not receiving antioxidant pharmacotherapy (AOT). Patients and methods: The study included 113 patients (aged 21–90 years; 47 males and 66 females) who received surgical intervention for OJ due to non-malignant (71%) or malignant tumor (29%) etiologies. Patients were divided into two groups: Group I (n = 61) who did not receive AOT and Group II (n = 51) who received AOT (succinate-containing drug Reamberin) as part of detoxification infusion therapy. The surgical approach and scope of interventions in both groups were identical. Dynamic indicators of endotoxicosis, cholestasis, and cytolysis (total, direct, and indirect bilirubin, alanine aminotransferase [ALT], aspartate aminotransferase [AST], alkaline phosphatase [AP] and gamma-glutamyltransferase [GGT]), kidney function (urea), lipid peroxidation (malonic dialdehyde, MDA), inflammation (leukocytosis), and glycolysis disorders (lactate dehydrogenase (LDH), glucose) were evaluated. Results: Tumor jaundice, unlike non-tumor jaundice, persisted and was characterized by a more severe course, a higher level of hyperbilirubinemia, and lipid peroxidation. The prognostic value of the direct (and total) bilirubin, MDA, glycemia, and leukocytosis levels on the day of hospitalization, which increased significantly in severe jaundice and, especially, in deceased patients, was established. Decompression interventions significantly reduced levels of markers of liver failure, cytolysis, cholestasis, and lipid peroxidation on day 3 after decompression by 1.5–3 times from initial levels; this is better achieved in non-tumor OJ. However, 8 days after decompression, most patients did not normalize the parameters studied in both groups. AOT favorably influenced the dynamics (on day 8 after decompression) of total and direct bilirubin, ALT, AST, MDA, and leukocytosis in non-tumor jaundice, as well as the dynamics of direct bilirubin, AST, MDA, glucose, and LDH in tumor jaundice. Clinically, in the AOT group, a two-fold reduction in the operative and non-operative complications was recorded (from 23% to 11.5%), a reduction in the duration of biliary drainage by 30%, the length of stay in intensive care units was reduced by 5 days, and even hospital mortality decreased, especially in malignancy-induced OJ. Conclusion: A mechanism for the development of liver failure in OJ is oxidative stress with the appearance of enhanced lipid peroxidation and accompanied by hepatocyte necrosis. Inclusion of AOT in perioperative treatment in these patients improves treatment outcomes.

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Section: Introductionmentioning

confidence: 99%

Comparative Study of the Results of Operations in Patients with Tumor and Non-Tumor Obstructive Jaundice Who Received and Did Not Receive Antioxidant Therapy for the Correction of Endotoxemia, Glycolysis, and Oxidative Stress

et al. 2022

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“…Праздников с соавт. [8] на 166 пациентах с холедохолитиазом сравнили две методики эндоскопической папиллосфинктеротомии: ретроградную (n = 136) и антеградную (n = 30). Было установлено, что в случае выполнения ретроградной эндоскопической методики хирургическая эффективность составила 79,4 %, заболеваемость и смертность -13 % и 2 % соответственно.…”

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The Comparative Analysis of the Effectiveness of Endoscopic Transpapillary Interventions (Literature Review)

Ринчинов

Plekhanov

2019

Acta biomedica scientifica

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This article presents a comparative analysis of the effectiveness of endoscopic transpapillary management in patients with choledocholithiasis. The minimal complications are achieved using classical endoscopic papillosphincterotomy. However, in some cases, cannulation can be extremely difficult (stenosis, tumor of the major duodenal papilla, the anatomical features of the major duodenal papilla) or even impossible (wedged stone), and the introduction of a guidewire into the pancreatic duct significantly increases the risk of developing postoperative pancreatitis. The desire to increase the success when performing endoscopic papillosphincterotomy with diagnostic purpose (to perform endoscopic retrograde cholangiopancreatography after failure of traditional cannulation) and for the purpose of performing transpapillary operations has naturally led to the development of new non-standard methods of endoscopic papillotomy, the introduction of new instruments – wire guides and guided cannulas. Further increase in the frequency of successful endoscopic papillotomy can be facilitated by using atypical methods of surgery. Some authors show that classical papillosphincterotomy is comparable to the method of endoscopic papillosphincterotomy with balloon dilatation in effectiveness of extracting stones from the common bile duct. However, balloon dilatation in the extraction of choledocholithiasis is preferable due to fewer postoperative complications.The authors of this article note that endoscopic management do not always solve the problem of choledocholithiasis, but still have undeniable advantages compared with the laparotomy, in which choledocholithotomy sometimes has to be expanded, and duodenotomy with transduodenal papillosphincterotomy is conducted. Literature shows that main mortality causes after endoscopic interventions in patients with choledocholithiasis were progression of purulent cholangitis, biliary sepsis, acute postoperative pancreatitis, “discharge” syndrome.

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Characteristics of neutrophilic granulocytes of peripheral blood in patients with mechanical jaundice caused by cholangiocarcinoma

et al. 2022

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Obstructive jaundice caused by cholangiocarcinoma takes a special place among malignant disorders and surgical pathology in Russia. Involvement of nonspecific immunity and the role of neutrophils in carcinogenesis are ambiguously evaluated. The aim of this study was to study functional activity of peripheral blood neutrophilic granulocytes and their phenotype in obstructive jaundice caused by cholangiocarcinoma. The study included 56 patients with obstructive jaundice associated with cholangiocarcinoma at the T2- 3N0- 1M0 stage (clinical stages II-III), and 90 apparently healthy volunteers of similar age group. Neutrophilic granulocytes were isolated from peripheral blood by means of double-density Ficoll-Urografin gradient.Venous blood was collected in patients into vacutainers with heparin upon admission to the hospital, before the surgery was performed. Spontaneous cytokine production (IL-8, IFNá) was determined by enzyme-linked immunosorbent assay using Vector-Best diagnostic kits. To assess phagocytic activity of neutrophilic granulocytes, the phagocytic index (according to Hamburger), number of phagocytes (according to Wright) and the index of completed phagocytosis (according to Rudik, 2006) were calculated. Immunophenotyping of neutrophilic granulocytes was carried out using an FC500 flow cytometer (Beckman Coulter, USA) with monoclonal antibodies to CD11b+, CD16+, CD95+. The results were statistically analyzed using the Statistica v.12.0 software (StatSoft Inc., USA). To assess intergroup differences, the nonparametric Kruskal-Wallis tests (for three or more comparison groups) and Mann-Whitney tests (for pairwise comparison) were used. Comparison of groups for a qualitative binary trait was carried out using the two-sided Fisher’s exact test. Data are presented as Median (25 quartile-75 quartile).The study of the functional activity of peripheral blood neutrophiles in obstructive jaundice patients caused by cholangiocarcinoma revealed an increase in their relative and absolute number, increased phagocytic index and decreased phagocytic number of neutrophilic granulocytes, increased expression of CD11b+, CD16+, CD95+ immunological markers. The changes in neutrophil secretory activity were characterized by a decrease in cytokine production (IL-2, IFNá). An increase in functional activity of neutrophilic granulocytes, along with a decrease in their cytokine production suggests that, in obstructive jaundice observed in cholangiocarcinoma at clinical stage T2-3N0-1M0, an equilibrium stage is revealed between the cells of immune system and malignant tumor.

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Antegrade approach for cholangiolithiasis complicated by mechanical jaundice

Abstract: Antegrade interventional approach for minimally invasive procedures is technically feasible, has the same effectiveness as the retrograde endoscopic method and also all advantages of minimally invasive techniques.

Cited by 9 publications

References 7 publications

Comparative Study of the Results of Operations in Patients with Tumor and Non-Tumor Obstructive Jaundice Who Received and Did Not Receive Antioxidant Therapy for the Correction of Endotoxemia, Glycolysis, and Oxidative Stress

Comparative Study of the Results of Operations in Patients with Tumor and Non-Tumor Obstructive Jaundice Who Received and Did Not Receive Antioxidant Therapy for the Correction of Endotoxemia, Glycolysis, and Oxidative Stress

The Comparative Analysis of the Effectiveness of Endoscopic Transpapillary Interventions (Literature Review)

Characteristics of neutrophilic granulocytes of peripheral blood in patients with mechanical jaundice caused by cholangiocarcinoma

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