Percutaneous approach and rendezvous technique for the management of a cholangiolithiasis complicated by obstructive jaundice

Abstract

Aim. To improve the results of surgical treatment of patients with cholelithiasis complicated by cholangiolithiasis and obstructive jaundice, using percutaneous technologies.Materials and methods. The results of treatment of 50 patients with cholelithiasis complicated by cholangiolithiasis and obstructive jaundice, which was not possible to use the endoscopic retrograde method of treatment was analyzed. Two representative clinical groups were formed according to the para-copy method: patients of the 1st group used the percutaneous method of treatment of cholangiolithiasis, patients of the 2nd group used the rendezvous technique.Results. The duration of the operation in the first clinical group was 85.60 ± 8.50 minutes, in the second – 64.80 ± 6.41 minutes. Intraoperative blood loss in both groups is minimal. The duration of postoperative hospital stay was: in the first group – 12.10 ± 1.25 days, in the second – 12.00 ± 1.25 days. In the first clinical group, the complication rate is 12%, in the second – 16%. No deaths were observed. The use of percutaneous laser lithotripsy allowed us to achieve the effectiveness of treatment of cholangiolithiasis in all patients in both clinical groups. The average consumption of a contrast agent per patient in the first group is 250.00 ml ± 25.00 ml, in the second – 370.00 ml ± 35.00 ml. Repeated debridement interventions in the first group were required by 2 (8%) patients, in the second – 8 (32%) patients.Conclusion. The frequency of complications, the duration of hospital stay and the effectiveness of treatment are comparable in both groups. If there is percutaneous access, hardware, instrumental and personnel support for percutaneous lithoextraction, there is no need to switch to a retrograde method for resolving cholangiolithiasis. The percutaneous method is an alternative minimally invasive method for treating patients with cholangiolithiasis and obstructive jaundice, which is impossible to perform “traditional” interventions or is associated with a high risk.