TRANSPAPILLARY ENDOSCOPIC SURGERY: COMPLICATIONS AND PREVENTION OF THEIR DEVELOPMENT
Improvement of endoscopic techniques and tools, minimal invasiveness of transpapillary endoscopic surgery (TES), accumulated experience, as well as the introduction of preventive measures, do not always avoid the development of life-threatening complications (6.8 - 10,2% of patients) and deaths (1,7 - 3%). The purpose of the study is to assess the practical significance of the proposed predictors of TES complications in the treatment of patients with impaired patency of the ductal systems of the liver and pancreas, to propose program measures for the prevention of complications. The results of TES in 3305 patients performed in the planned and emergency order with various diseases of the hepatopancreatobiliary region are analyzed. Based on multivariate analysis, statistically significant (p <0.05) predictors of major life-threatening complications of TES were distinguished: 1) post-operative pancreatitis (female (78.2%), difficult cannulation (54.6%), multiple cannulation, fast / tight contrasting pancreatic duct (49.4%)); 2) bleeding (current mode (52.1%), presence of cholangitis (43.5%), coagulopathy in the presence of jaundice (65.2%)); 3) duodenum perforation (elderly and senile age (68.2%), difficult cannulation (66.7%)); 4) acute cholangitis (inadequate drainage of the bile ducts (83.3%), unsuccessful attempt to drain the bile ducts (48.6%)). We are supplemented prophylactic measures for postoperative complications in case of TES. A personalized record of the main predictors of complications of the feasibility study and the use of a program of preventive measures will allow an adequate choice of tactical approaches and technical options for operations, which will lead to improved treatment outcomes, minimizing the frequency of complications and mortality.