Combined application of minimally invasive technologies in the treatment of obstructive jaundice

Карпов, О Э; Ветшев, П С; Бруслик, С. В.; Маады, А. С.; Левчук, А Л; Sviridova, T. I.

doi:10.16931/1995-5464.20192100-104

Cited by 6 publications

(3 citation statements)

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“…In recent years, with the accumulation of experience in endoscopic surgery of choledocholithiasis, new approaches have emerged aimed at wider application of sphincter-preserving interventions (8). The treatment of choledocholithiasis is multivariate and each method has both advantages and disadvantages, therefore rational tactical approaches and the search for new technical solutions for the removal of biliary tract concretions are required (9). Mechanical jaundice is the most common and severe syndrome of surgical diseases of the hepatopancreatobiliary zone with a frequency ranging from 4.8% to 83%, with severe complications of MJ, such as purulent cholangitis, systemic inflammatory response syndrome, sepsis, as well as multiple organ dysfunction (10) and mortality in emergency operations reaches 15-30% (11).…”

Section: Introductionmentioning

confidence: 99%

Algorithm of surgical tactics and surgical treatment of cholelithiasis complicated by multiple choledocholithiasis

Aimagambetov¹,

Masalov²,

Bulegenov³

et al. 2022

HVT

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Objective: Biliary stone disease is now one of the most common diseases, affecting 10-20% of the world's population. One of the most important problems in biliary tract surgery is the treatment of choledocholithiasis, which occurs in 10 to 38% of biliary stone disease according to different authors. Our research has allowed us to outline the most rational ways of treating patients in modern conditions. In our research, we focus on “the golden mean'” - a combination of staged minimally invasive interventions and standard interventions. Aim of our study was to evaluate the results of postoperative complications using the developed algorithm of surgical tactics and choledochoduodenoanastomosis from a minimally invasive approach. Methods: Overall, 35 patients who underwent surgical treatment of cholelithiasis, cholangitis, benign genesis obstructive jaundice (BGOJ) were included to the study. All patients were divided into two groups (main group and comparison group) depending on the method of treatment used. The study group consisted of 17 (48.6%) patients who underwent bile outflow restoration of choledochal outflow obstruction of the terminal section (choledochodenoanastamosis according to the developed by us procedure (Kazakhstan patent №108142, Algorithm of diagnostics and surgical treatment tactics of benign genesis obstructive jaundice - Author's certificate № 24754. Control group consisted of 18 (51.4%) patients who underwent cholecystectomy, choledocholithiasis by Jurash-Vinogradov and applied conventional algorithm of diagnostics and treatment of multiple choledocholithiasis with benign genesis obstructive jaundice. We assessed complications of procedures according to Clavien-Dindo and pain intensity level using visual analog score in both groups. Results: When using the proposed algorithm and new methods of surgical treatment in patients in the study group the rate of complication was lower in the study group as compared to control group (p=0.04): there was no deficiency and bleeding from the anastomosis, while in control group they turned out to be in 1 case. Complications in the form of seroma in 2 cases and bleeding into the subcutaneous tissue of the postoperative wound were in 1 case, being the same as in control group. No mortality was recorded in any group. The pain level was lower in the study group as compared to control group (p<0.05). Conclusions: Thus, the application of our algorithm for the diagnosis and surgical tactics of treatment of obstructive jaundice of benign genesis makes it possible to determine the tactics of surgical treatment of patients with obstructive jaundice. The developed technique for the surgical treatment of choledocholithiasis in cholelithiasis ensures the restoration of bile outflow in the duodenum, normalizes its morphofunctional state, prevents the development of various postoperative complications, in particular, there was no leakage and bleeding from the choledochoduodenoanastomosis in the main group.

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Section: Introductionmentioning

confidence: 99%

Algorithm of surgical tactics and surgical treatment of cholelithiasis complicated by multiple choledocholithiasis

Aimagambetov¹,

Masalov²,

Bulegenov³

et al. 2022

HVT

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“…Postoperative mortality in jaundice of "benign genesis" is 5.6-6.3%, with jaundice of "tumor genesis" -10.6-25.7%. Sometimes, due to the severity of the condition of patients after palliative surgery, the mortality rate may be higher than after radical interventions [33]. An indisputable risk factor for the development of a destructive-inflammatory process in the area of the gallbladder neck (Hartmann pocket), cystic duct, is the presence of calculous cholecystitis, leading to narrowing of the hepatic duct and the formation of vesicocholedochal fistula [34].…”

Section: Introductionmentioning

confidence: 99%

Obstructive jaundice syndrome of benign genesis and its surgical treatment

Omarov¹,

Аймагамбетов²,

Auyenov³

et al. 2022

ijhs

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Introduction: Obstructive jaundice in surgical hospitals is relatively common (2.6-23.7%). And it is one of the leader in the liver failure development with the severe homeostasis disorders appearanced. So, the analysis of the results of improving the surgical treatment of obstructive jaundice syndrome of benign genesis has been conducted from 2015 to 2019. Materials and Methods: The results of surgical treatment of 142 patients with cholelithiasis (gallstone disease) complicated by obstructive jaundice of benign genesis were analyzed: 95 females (66.9%) and 47 (33.1%) male patients. Patients were divided into two groups (experimental and control) according to the surgery method was used. Results: 5 complications (7.2%) and in 5 patients (7.2%) were fixed in the experimental group. However, only in a single complication was the II degree of severity according to the Clavien-Dindo classification. Control group had more complications cases: 18 (24.7%) in 13 patients (17.8%) ‑ (χ2=7.922, p=0.005). Mortality rate was also different: absent in the main group and 4 cases (5.5%) in the control one because of hepatic-renal failure against the background of severe intoxication (2 cases), massive pulmonary embolism (1 case), and disseminated intravascular coagulation syndrome (1 case).

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“…Однако возможна и оппоненция этого постулата. Основой тому является индивиду альная реактивность организма, которая зависит от многих факторов как наследственного, так и приоб ретенного характера [1,2]. С целью объективизации выраженности различных патологий используют все возможные критерии, разработаны различные шкалы, что позволяет в максимальной степени своевременно определить тяжесть болезни и на этой основе сформи ровать адекватные схемы терапии [3,4].…”

Section: Introductionunclassified

A Method for Assessing the Severity of Obstructive Jaundice of Non-Neoplastic Origin

Власов

Sheyranov

Маркин

et al. 2021

Neotložnaâ med. pomoŝʹ

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AIM OF STUDY To develop a method for assessing the severity of obstructive jaundice (OJ) of non-neoplastic orogin on the basis of functional parameters of the liver and the activity of pathogenetic agents of hepatodepression.MATERIAL AND METHODS Clinical and laboratory studies of 142 patients with breast cancer of non-tumor origin. The indicators of the functional state of the liver, the index of plasma toxicity for albumin, and the content of malondialdehyde (MDA) were evaluated.RESUlTS Based on the assessment of a number of blood parameters - the content of total bilirubin (TB), the plasma toxicity index for albumin, the MDA level — the severity index of obstructive jaundice of non-neoplastic origin (SIOJ) was developed:SIOJ = IT1/ITn + TB1/TB + 5(MDA1/MDAn)where IT 1 is the plasma albumin toxicity index at the current moment, ITn is the normal albumin plasma toxicity index, TB1 is the current bilirubin content, TBn is the normal bilirubin content, MDA1 is the current malondialdehyde content, MDAn is the normal value. The index less than 13 indicates a mild severity, 14–21 is moderate severity, 22 and higher indicates a severe degree of OJ. The method increases the objectivity of determining the severity of non-neoplastic origin by establishing the severity of liver damage and the processes underlying it.CONClUSiON The suggested clinical and laboratory index allows the severity of obstructive jaundice to be objectively and quickly determined upon admission of a patient to the hospital and also adequate therapy to be initiated in case of severe degree for anticipation of possible post-operative complications, so the treatment should be focused on managing triggers of hepatodepression. The method is simple and available in medical institutions of various levels. The method is especially valuable when used in the dynamics of the early postoperative period.

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Combined application of minimally invasive technologies in the treatment of obstructive jaundice

Abstract: Successful combined minimally invasive intervention (antegrade and retrograde) in a patient with choledocholithiasis and previous pancreatoduodenectomy is described in the article.

Cited by 6 publications

References 1 publication

Algorithm of surgical tactics and surgical treatment of cholelithiasis complicated by multiple choledocholithiasis

Algorithm of surgical tactics and surgical treatment of cholelithiasis complicated by multiple choledocholithiasis

Obstructive jaundice syndrome of benign genesis and its surgical treatment

A Method for Assessing the Severity of Obstructive Jaundice of Non-Neoplastic Origin

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