Antegrade minimally invasive technologies in treatment of complicated cholelithiasis

Abstract

Aim. To evaluate the potential and effectiveness of antegrade X-ray surgical interventions as treatment choice to eliminate the cholecysto- and choledocholithiasis in the complicated cholelithiasis.Materials and methods. We carried out an analysis of the results of staged X-ray surgical treatment of 29 patients with cholecysto- and/or choledocholithiasis having relative or absolute counterindications to the implementation of laparoscopy, open surgery or endoscopy. Thirteen patients (44.8%) were revealed to have diverticulum of the major duodenal papilla; seven (24.1%) – coronary heart disease with chronic heart failure. Five patients (17.2%) had previously undergone gastrectomy. Severe diseases of the respiratory organs were detected in four cases (13.7%). The primary intervention included percutaneous microcholecystostomy and percutaneous transhepatic cholangiostomy. The drainage channel formation was followed by cholecysto- and choledocholangioscopy, mechanical and pneumatic lithotripsy, lithoextraction.Results. A total of 34 percutaneous minimally invasive interventions were performed. Percutaneous transhepatic biliary drainage was performed in 23 cases (67.6%), percutaneous microcholecystostomy – in seven (20.5%), and percutaneous drainage of peri- and intrahepatic abscesses was additionally carried out in four cases (11.9%). At the second stage, seven patients (24.4%) underwent cholecystoscopy and 20 (68.8%) – choledocholangioscopy. Both interventions were used in two cases (6.8%). In all cases, the work resulted in eliminating the complications of cholelithiasis, cholecystosis and/or choledocholithiasis with restorating the bile passage by means of percutaneous minimally invasive technologies. No fatal outcomes or complications were recorded.Conclusion. Antegrade X-ray surgical technologies are effective minimally invasive choice treatment to eliminate the cholecysto- and choledocholithiasis with counterindications to other surgical treatments in the complicated cholelithiasis.