Introduction. Indications for laparoscopic cholecystectomy (LCE) performing continue to be expanded for more than 25 years since its first performance by a French surgeon F. Dubois. Endovideosurgical and, especially, laparoscopic technologies are positioned strongly on a leading places in the choice of treatment management of patients in various fields of surgery. They are also progressively spread to related medical specialties giving them a new impulse for accelerated development.
After results of long-term clinical follow-up and surgical treatment of patients with hepatic insufficiency (HI) analysis we came to the conclusion that in some cases this pathology develops as a result of ineffective treatment of patients with obstructive jaundice (OJ).
Aim of the work — to estimate the effectiveness of patients with mechanical jaundice (MJ) two-step method of treatment focusing on the liver functional state during the postoperative period.
Materials and methods. The authors reported clinical observations about the surgical treatment of patients with OJ using a variety of diagnostic and operational paradigms. 164 patients at age 32 to 72 years were under the supervision — they were operated because of MJ during the last three years.
According to the treatment result, all patients were retrospectively randomized into 2 groups: the 1st group patients (n=101, 61.6%) were undergone two-stage surgery with endoscopic papillosphincterotomy (EPST) on the first and LCE in the second stage of surgical treatment. 63 patients (38.4%) out of the 2nd group were forced to carry out an open surgery for choledocholithiasis in the first stage and/or open cholecystectomy (OCE) in the second stage of the performed surgical treatment.
The efficacy of the treatment was estimated during the first 7–10 days immediately after the surgery and 3 months after patients left surgical department.
Results and discussion. EPSP was done in 98 (59.8%) patients, 88 cases of them (53.7%) were due to choledocholithiasis. EPSP finished by lithextraction in 59 patients (66.0%), by mechanical lithothrypsy — in 29 patients (17.7%).
LCE was performed in 98 patients 1–5 days after EPST and to all patients in the 1st group. Surgical intervention started laparoscopically, conversion was done in 25 patients. There were 6 cases of complications (5.9%) among the patients of 1st group which were eliminated during the postoperative period. All patients were alive at the time of 3 months after surgery. Clinical and laboratory checkings confirmed satisfactory level of liver functioning. Only 2 patients had transient hyperamylasemia. There were 12 cases (19.0%) of complications in patients of the 2nd group that was higher compared with the same index in the 1st group patients (p<0.01). The clinical indexes of hepatic insufficiency development were present in 9 patients (14.3%) of the 2nd group that was also greater compared in group N 1 (p<0.01).
According to these data the authors recommend an individual approach to the choice of surgical treatment in each case, the operative interventions performing in the so-called “cold period”, obvious analysis of possible high operational and anesthetic risk including the patient’s age. The stages of surgical intervention in patients with obstructive jaundice and choledocholythiasis are the priority method of effective surgical treatment. The laparoscopic but not open cholecystectomy performing at the second stage of treatment prevents hepatic insufficiency formation in patients throughout the postoperative period.