ANTEGRADE LASER PAPILLOTOMY UNDER THE CONTROL OF VIDEO CHOLEDOCHOSCOPY IN PATIENTS WITH STENOSIS OF THE LARGE DUODENAL PAPILLA COMPLICATED WITH MECHANICAL JAUNDICE
https://doi.org/10.17709/2409-2231-2018-5-2-2
Abstract
Purpose. To analyze the efficacy of the YAG:Ho laser in laparoscopic treatment of large duodenal papilla (LPA) stenosis complicated by mechanical jaundice.
Patients and methods. The work is based on a prospective analysis of 31 patients undergoing treatment in the KhMAO-Ugra BU “NyaganDistrictHospital”. To perform antegrade laser papillotomy, a laser setup equipped with high-energy YAG: Ho laser, endovideosurgical complexes and a fibrocholedochoscope was used. During laparoscopic cholecystectomy, intraoperative choledochoscopy and antegrade laser papillotomy were performed.
Results. Laser papillotomy was successfully performed in 31 (100%) patients with benign stenosis of LDP, among them in 15 patients (48.4%) the stenosis of LDP was combined with choledocholithiasis, which was detected intraoperatively in 9 (29.0%) cases. For optimal conduction of choledochoscopy, a guide device for a choledochoscope has been proposed (RF patent for utility model No. 149055 dated May 12, 2014).
All surgical interventions, including lithotripsy, were performed laparoscopically, there was no indication for conversion.
Conclusion. The received results show high efficiency of the applied technique, absence of complications and lethal outcomes. Antegrade laser papillotomy is effective even in those situations where endoscopic retrograde papillosphincterotomy is technically difficult or impracticable.
About the Authors
N. V. Levchenko
Khanty-Mansiysk State Medical Academy;
The Nyagan District Hospital
Russian Federation
Russian Federation
Nikolai V. Levchenko, MD, PhD, surgical doctor of the surgical department №1,NyaganDistrictHospital
V. V. Khryachkov
Khanty-Mansiysk State Medical Academy;
Russian Federation
Valerii V. Khryachkov, MD, PhD, DSc, professor of hospital surgery chair
Russian Federation
Valerii V. Khryachkov, MD, PhD, DSc, professor of hospital surgery chair
R. R. Shavaliev
Khanty-Mansiysk State Medical Academy;
The Nyagan District Hospital
Russian Federation
Russian Federation
Rafael’ R. Shavaliev, surgical doctor of the surgical Department №1, The Nyagan District Hospital
For correspondence: Address: 12 Zagorodnykh str., Nyagan’ 628181, Russian Federation
D. P. Kislitsin
Khanty-Mansiysk State Medical Academy;
District Clinical Hospital
Russian Federation
Russian Federation
Dmitrii P. Kislitsin, MD, PhD, associate professor, head of the department of hospital surgeryKhanty-MansiyskStateMedicalAcademy, head of the surgical department ofDistrictClinicalHospital, chief freelance surgeon of the department of health KHMAO-Yugra Tyumen region
References
1. Andreev AL, Rybin EP, Uchvatkin EG, Filin AS, et al. Kombiniro¬vannaya endoskopicheskaya khirurgiya zhelchnokamennoi bolezni, oslozhnennoi zabolevaniyami terminal’nogo otdela obshchego zhelchnogo protoka. Vestnik khirurgii imeni I.I.Grekova. 1997;156(3):30-4. (In Russian).
2. Vetshev RS. Bstructive jaundice: caused and diagnostic approaches (lecture). Annaly khirurgicheskoy gepatologii (Annals of Surgical Hepatology). 2011;16(3):50-7. (In Russian).
3. Gal’perin EI, Vetshev PS. Rukovodstvo po khirurgii zhelchnykh putei [Manual of surgery of the biliary tract]. Мoscow: “Vidar-M” Publ., 2009, 568 p. (In Russian).
4. Glebov KG, Kotovskiy AE, Dyuzheva TG. Criteria for the Choice of Construction of Endoprosthesis for Endoscopic Biliary Stent¬ing. Annaly khirurgicheskoy gepatologii (Annals of Surgical Hepatology). 2014;19(2):55-65. (In Russian).
5. Parkhisenko YuA, Zhdanov AI, Parkhisenko VYu, Kalashnik RSObstructive Jaundice – Modern Views on the Problem of Diagnosis and Surgical Treatment. Ukrainian Journal of Surgery. 2013;3(22):202-14. (In Russian).
6. Catheline J-M, Turner R, Rizk N, Barrat C, Buenos P, Champault G.Evaluation of the biliary tree during laparoscopic cholecystec¬tomy: laparoscopicultrasound versus intraoperative cholangiog¬raphy: a prospective study of 150 cases. Surg Laparosc Endosc. 1998 Apr;8(2):85-91.
7. Golden WE, Cleves MA, Johnston JC. Laparoscopic chole¬cystectomy in the geriatric population. J Am Geriatr Soc. 1996 Nov;44(11):1380-3.
8. Ermolov AS, Ivanov PA, Blagovestnov DA, Demchenko SS, No¬vosel SN, Almakaev FR. Tactics of treatment of the acute chole¬cystitis complicated by choledocholithiasis. Khirurgiya. Zhurnal imeni N.I. Pirogova (Journal Surgery named after N.I. Pirogov). 2014;1:10-4. (In Russian).
9. Mikhaylusov SV, Moiseyenkova YeV, Misrokov MM. Course of pancreatic necrosis on a background of major duodenal papilla stone. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2014;24(6):29-35. (In Russian).
10. Parfenov IP, Jarosh AL, Sergeev OS, Soloshenko AV, Karpa¬chev AA. Forecasting of Acute Biliary Pancreatitis Development in Impacted Ampullary Stone. Annaly khirurgicheskoy gepatologii (Annals of Surgical Hepatology). 2010;15(2):87-91. (In Russian).
11. Slavin LE. Laparoscopic cholecystectomy. Practical Medicine. 2010;41:30-5. (In Russian).
12. Starkov YuG, Strekalovskii VP, Grigoryan PC, Rizaev KS, et al. Antegradnaya papillosfinkterotomiya vo vremya laparoskopi¬cheskoi kholetsistektomii. Annaly khirurgicheskoy gepatologii (Annals of Surgical Hepatology). 2001;6(1):99-106. (In Russian).
13. Voitk A. Its outpatient cholecystectomy safe for the hingerri¬scelective patient. Surg Endosc. 1997 Dec;11(12):1147-9.
14. Wojtuń S, Gil J, Zyśko B. The use of endoscopic method in treatment of strictures of biliary tree. Pol Merkur Lekarski. 2007 May;22(131):477-81.
15. Beburishvili AG, Mandrikov VV, Zyubina EN, Turovets MI, et al. Profilaktika ostrogo pankreatita pri endoskopicheskikh transpapillyarnykh vmeshatel’stvakh u patsientov s vysokim riskom ego razvitiya. Endoskopicheskaya khirurgiya (Endoscopic Surgery). 2014;20(1):69-70. (In Russian).
16. Krasilnikov DM, Zakharova AV, Mirgasimova DM, Nigmatzyanov RI. Comprehensive treatment of patients with obstructive jaundice. Practical Medicine. 2014;5(81):71-74. (In Russian).
17. Maistrenko N.A., Stukalov V.V. Kholedokholitiaz [Chole¬docholithiasis]. St.Petersburg: “ELBI-SPb” Publ., 2000. 285 p. (In Russian).
18. Shapoval’yants SG, Ardasenov TB, Freydovich DA, Mylnikov AG, Pan’kov AG, Budzinsky SA, Nikonov AA. Problems of modern diagnostics of choledocholithiasis. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2011;2:22-9. (In Russian).
19. Bagnato V. J. Laparoscopic choledohoscopy and choledoholi¬totomy. Surg Laparosc Endosc. 1993 Jun;3(3):164-6.
20. Geynits AV, Maximenkov AV, Saakjan OV, Yafarov AR. Cholelithiasis modern possibilities of surgical treatment (liter¬ature review). Laser Medicine. 2010;14(4):49-59. (In Russian).
21. Khryachkov VV, Levchenko NV, Shavaliev RR. 149055 patent of the Russian Federation. Guide device for the choledochoscope. 12.05.2014. URL: http://poleznayamodel.ru/model/14/149055. html (accessed 15.09.2016). (In Russian).
Review
For citations:
Levchenko N.V., Khryachkov V.V., Shavaliev R.R., Kislitsin D.P. ANTEGRADE LASER PAPILLOTOMY UNDER THE CONTROL OF VIDEO CHOLEDOCHOSCOPY IN PATIENTS WITH STENOSIS OF THE LARGE DUODENAL PAPILLA COMPLICATED WITH MECHANICAL JAUNDICE. Research and Practical Medicine Journal. 2018;5(2):19-25. (In Russ.) https://doi.org/10.17709/2409-2231-2018-5-2-2
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