ONE-STEP TACTICS OF SURGICAL TREATMENT OF ACUTE CHOLECYSTITIS IN COMBINATION WITH CHOLEDOCHOLITHIASIS.

Abstract

Introduction: Concrements of the common bile duct (choledocholithiasis) occur from 8% to 20% in patients with acute cholecystitis. This pathology requires simultaneous correction of the pathology of the gallbladder and the common bile duct.

Methods: We retrospectively analyzed the case histories of 135 patients who underwent endoscopic retrograde cholangiopancreatography, endoscopic papillosphincterotomy, choledocholithoextraction followed by laparoscopic cholecystectomy+CHEST+LCE) for acute cholecystitis in combination with choledocholithiasis in the period from January 2016 to March 2021. Patients who underwent simultaneous treatment (ERCP+EPST+CLE+LCE under one anesthesia) were assigned to the OS group (n=63), patients who underwent two-stage treatment (ERCP+EPST+CLE and LCE on the 3-4th day during one hospitalization) were assigned to the TS group (n=72). All endoscopic procedures in both groups were performed by the same endoscopist using the same technique.

Result: There were significant differences between the groups in terms of the duration of anesthesia, the dynamics of the decrease in the blood serum of the total bilirubin and the leukocytes range at the postoperative period, the frequency of postoperative complications and the duration of the average hospitalization in favor of one-stage treatment.

Conclusions: One-time treatment tactic is safe and optimal for the treatment of acute cholecystitis combined with choledocholithiasis, characterized by a short hospital stay, a low rate of episodes of acute cholecystitis and recholedocholithiasis, which often occur with two-stage (TS) treatment tactics.