Improving treatment outcomes for acute biliary pancreatitis

Abstract

Background: Improvement of the results of surgical treatment of acute biliary pancreatitis (BP), using combined mini-invasive technologies. Methods: The work is based on an analysis of the results of diagnosis and treatment of 126 patients with acute BP. The age of the patients ranged from 21 to 82 years. Among the women patients there were 92 (73.0%), men-34 (27.0%). In the diagnosis of acute BP, the complex was approached, including an analysis of complaints, anamnesis data, an objective examination, laboratory and instrumental methods of investigation. Results:The study of cytokine status in patients with BP in the presence of purulent cholangitis against a background of conservative therapy revealed an increase in the concentration in the blood plasma of TNF-a, IL-6 and IL-8 in the first 3-4 days, and IL-4-7 days after surgery with further decrease. The combination of minimally invasive interventions with conservative therapy effectively reduced the levels of TNF-a, IL-4 and IL-6 in the bile of patients with BP forms that compared with the preoperative period in bile the concentration of TNF-a, IL-4 and IL-6 was significantly less at 71.0, 47.7 and 70.6% respectively. In order to predict the risk of BP development, a method of endoscopic ultrasonography was developed, which in 96% of the observations confirmed the presence of BP. In the postoperative period after the combined minimally invasive interventions against the background of the therapy, for the first 3 days, the improvement of the condition was noted in all 60 patients. The average bed-day, at the same time, was 8.4 ± 1.2 days, compared with the patients in the second group, which amounted to 26.6 ± 2.4 days. Postoperative complication was noted in 5 (8.3%) patients, in contrast to 12 (18.2%) in the group of patients after traditional operations. Two (3.0%) patients died after the traditional operation from the progressive phenomena of multi-organ failure. Conclusions: Modern laboratory and instrumental research methods can characterize and predict complications of biliary pancreatitis. And combined minimally invasive interventions allow to improve the immediate results of treatment of BP.