Endobiliary Interventions via Transgallbladder Access in Staged Mini-invasive Treatment of Complicated Cholelithiasis
Aim. To improve the results of minimally invasive treatment of choledocholithiasis by antegrade endobiliary transvesical interventions. Material and Methods. Minimally invasive access into bile ducts through the cystic duct was successfully implemented in 36 (70.6%) patients after prior contact lithotripsy and antegrade lithoextraction for relief of acute obstructive cholecystitis in high risk patients. Different manipulative angiographic catheters (5 Fr) and hydrophilic guidewires (0.018'', 0.025'', 0.035'') were used for cystic duct catheterization. Was considered that cystic duct intubation with proportionate introducer with radiopaque marker is optimal for subsequent manipulations on common bile duct. Results. In 12 cases externally-internal drainage or guidewire for endoscopic papillotomy were deployed after transvesical catheterization of common bile duct. In 24 cases papillodilatation by antegrade balloon catheter, dislocation of stones fragments and biliary sludge into duodenum and antegrade balloon examination of distal common bile duct were performed. There were no complications after the procedure. Conclusion. Transvesical X-ray surgical access into common bile duct can be successfully used as an element of “rendezvous” technology for antegrade transpapillary navigation of guidewire followed by conventional endoscopic procedure. The method provides balloon dilatation of major duodenal papilla, externally-internal drainage of common bile duct and also dislocation of stones from common bile duct into duodenum in clinically difficult cases.