Prevention and treatment bile ducts injuries in patients with acute cholecystitis

Abstract

Aim. To develop rational surgical tactics for the treatment and prevention of bile duct lesions in patients with acute calculous cholecystitis. Materials and methods. The results of examination and surgical treatment of 1,645 patients with acute calculous cholecystitis at the second and third levels of medical care were studied. The results of diagnostics and elimination of the bile ducts injuries in 21 patients who developed during laparoscopic cholecystectomy for acute cholecystitis in second-level medical institutions were analyzed. Integrative assessment of the examination results is based on taking into account the results of laboratory and instrumental examination. Based on the analysis, a rational treatment strategy for this category of patients was formed and tested. Results. The main factors that influenced the occurrence of bile duct injuries were: performing the operation in an inflammatory infiltrate and within 72 hours of the onset of the disease, intrahepatic location of the gallbladder, male gender and age over 63 years (p ≤ 0.05). The provision of assistance in case of complete damage to the main bile ducts in medical organizations of the second level should be completed by performing external drainage with further evacuation of the patient, after stabilization of his condition, to medical institutions of the third level. Partial common bile ducts injury can be eliminated by performing restorative suturing of the defect of the common bile duct the T-drainage at all levels of healthcare organization. It was clarified that patients with acute cholecystitis Grade I are shown timely laparoscopic cholecystectomy within 72 hours from the onset of the disease. For patients with acute Grade II cholecystitis complicated by inflammatory infiltrate, without signs of destruction and blockage of the gallbladder at all levels of medical care it is advisable to conservative treatment, surgery after 3 months. With the progression of endogenous intoxication with destruction of the gallbladder, cholecystostomy is advisable. Patients with acute grade II cholecystitis and complicated course who are being treated in a second-level medical organization, are shown to be transferred to a third-level medical organization for endoscopic intervention on the duodenal papilla. Conclusion. Implementation of the proposed surgical tactics for patients with acute cholecystitis allows performing timely and rational surgical intervention, increasing the effectiveness of treatment, reducing the number of postoperative complications and mortality.