Peculiarity of Surgical Management of Difficult Common Bile Duct Stones
Aim. Evaluation of endoscopic retrograde and traditional surgical interventions effectiveness in complex forms of chole-docholithiasis. Materials and methods. Complex forms of choledocholithiasis (large size, atypical abnormal form and localization of stones, deviation of pancreatobiliary zone anatomy) was diagnozed in 275 patients. 202 (73.5%) patients had jaundice in admission time, 67 (24.4%) — cholangitis and 8 (2.9%) — acute biliary pancreatitis in. Surgical interventions began with transpapillary procedures. Results. Endoscopy was not feasible in 12 (4.4%) cases (a large duodenal diverticulum — 3, ulcerative pyloric stenosis — 2, Zenker's diverticulum — 1, long jejunal loop after gastric resection and gastrectomy — 6). Other 263 (95.6%) patients underwent endoscopic surgery followed by obstructive jaundice resolution in 93.6% and complete stone removal in 65.8% of patients. Complications of endoscopic treatment developed in 22 (8.4%). Mortality in the group of difficult choledocholithiasis came to 5.1% (n = 14). Conclusions. Transpapillary endoscopic interventions are highly effective in difficult forms of choledocholithiasis. Most important seems to be objective estimation of minimally invasive interventions risks timely distinguishing patients for reasonable traditional surgery of difficult types of choledocholithiasis