SINGLE-STAGE SURGICAL TACTICS - AS A DIFFERENTIATED APPROACH IN THE TREATMENT OF ACUTE CHOLECYSTITIS IN COMBINATION WITH CHOLEDOCHOLITHIASIS
Resume: Stones of the common bile duct (choledocholithiasis) occur from 8% to 20% in patients with acute cholecystitis. This pathology requires solving the problem from the side of the gallbladder and the common bile duct at the same time. Aim: Justification of effectiveness (hospital stay, frequency of complications, duration of anesthesia, laboratory data) of the use of single-stage surgical treatment tactics for acute cholecystitis combined with choledocholithiasis. Research methods: We retrospectively analyzed the medical histories of 135 patients who underwent endoscopic retrograde cholangiopancreatography, papillosphincterotomy with choledocholithextraction followed by laparoscopic cholecystectomy (ERCP+EPST+CLE+LC) for acute cholecystitis in combination with choledocholithiasis from January 2016 to March 2021. Patients who underwent single-stage treatment tactics (ERCP+EPST+CLE+LCunder one anesthesia) were assigned to the main group (n = 63), patients who underwent two-stage treatment tactics (ERCP+EPST+CLE+LC on the 3rd-4th day in one hospitalization) were assigned to the comparative group (n = 72). All endoscopic procedures in both groups were performed by the same endoscopist using the same technique. Results: We compared the results of treatment of patients between the two groups. In the comparative group, cholecystectomy was performed on the 3rd-4th day after ERCP+EPST within the framework of one hospitalization. There were significant differences between the groups in the time of anesthesia, in the dynamics of a decrease in total bilirubin and blood leukocyte in the postoperative period, the frequency of postoperative complications and mean hospital stay. At the same time, no fatal cases were registered in the studied groups. Conclusions: Single-stage surgical treatment tactics is a safe and optimal method for the treatment of acute cholecystitis combined with choledocholithiasis, characterized by a short hospital stay, a low rate of episodes of acute cholecystitis and reholedocholithiasis, which often occur with two-stage treatment tactics.