The standardisation of applying minimally invasive methods in treatment of post-laparoscopic cholecystectomy bile leakage

Abstract

Introduction. The paper analyses the results of surgical treatment of 10758 patients with cholelithiasis who underwent laparoscopic cholecystectomy. In the early postoperative period 63 patients (0.59%) had bile leakage. Materials and methods. There were 21 (33.3%) patients with a diagnosis of chronic cholecystitis and 42 (62,7%) patients with acute cholecystitis. In 53 (84.1%) cases there was a drainage bile leakage, in 10 (15.9%) cases bile leakage was diagnosed after the drainages were removed. In 22 (34.9%) cases daily volume of bile was 150-200 ml, in these cases patients underwent active aspiration, antibacterial and deintoxicating therapy. In case of drainage leakage was more than 200 ml 2-3 days after operation, 23 (36.5%) patients underwent biliary system decompression through endoscopic papillotomy or conducting nasobiliary drainage. In 10 cases EPST with nasobiliary drainage was effective and bile leakage was eliminated in 5 to 8 days. If ERCP and EPST weren’t effective, stomach pain remained or grew even stronger and there were intoxication and peritoneal symptoms, 13 (20.6%) patients had undergone relaparoscopy. Results. Developed surgical technique is based on ultrasound data and endoscopic retrograde cholangiopancreatography and is able to improve the results of treatment and avoid septic complications and lethal outcomes. Conservative treatment, minimally invasive endoscopic techniques, ultrasound guided puncture methods and relaparoscopy were effective in 55 patients (87.3%). Conclusion. The standardization of complex relaparoscopy application, transduodenal endoscopic interventions and paracentesis techniques allows to decrease essentially a number of laparotomic operation