ABSTRACT
In 748 patients, ageing 28-80 yrs, residual calculi of common biliary duct were removed, using various methods. Transfistular removing of biliary calculi was the method of choice in presence of external drain and endoscopic papillosphincterotomy (EPST) - in its absence. Efficacy of the first variant have had constituted 95.2% and of the second--88%. In 9.5% patients the reoperations were performed--open or laparoscopic. Late results in majority of patients were studied in terms not less than 3 years. Good late results of transdrainage nonoperative elimination of calculi in the first 3 years have had constituted 90% and in the next 6-10 years--99%; while in EPST--accordingly, 85 and 88%. In spite of constantly widening possibilities of the residual choledocholithiasis elimination the main task for modern biliary surgery--the prophylaxis of this not rare complication of cholelithic disease--persist.
Subject(s)
Cholecystectomy/adverse effects , Choledocholithiasis , Adult , Aged , Aged, 80 and over , Cholangiopancreatography, Endoscopic Retrograde , Choledocholithiasis/diagnosis , Choledocholithiasis/etiology , Choledocholithiasis/surgery , Choledochostomy , Drainage , Humans , Middle Aged , Reoperation , Sphincterotomy, Endoscopic , Treatment OutcomeABSTRACT
The results of treating 29 patients with Mirizzi syndrome are analyzed: 17 patients underwent traditional surgery, 11 patients--laparoscopic procedures, and endoscopic sphincterotomy with nasobiliary drainage was performed in a type I patient. Laparoscopic operations were performed in patients with types I and II syndrome, patients with types III and IV had only open surgery. In 2 cases operations were complicated by iatrogenic injury to the hepaticocholedochus, in 4 cases--by residual bile duct stones. Pronounced inflammatory alterations and scarring of the hepaticocholedochus, III and IV types of the syndrome were considered as indications for prolonged temporary stenting with plastic stents in 12 patients. Long-term results were studied with follow-up from 1.5 to 9 years. No patients out of 29 suffered cholangitis or biliary strictures.
Subject(s)
Cholecystectomy, Laparoscopic/methods , Cholecystitis/surgery , Cholestasis/etiology , Common Bile Duct Diseases/surgery , Cystic Duct/surgery , Hepatic Duct, Common/surgery , Biliary Fistula/diagnosis , Biliary Fistula/etiology , Biliary Fistula/surgery , Cholangiopancreatography, Endoscopic Retrograde , Cholangitis/diagnosis , Cholangitis/etiology , Cholecystitis/complications , Cholecystitis/diagnosis , Chronic Disease , Common Bile Duct Diseases/diagnosis , Common Bile Duct Diseases/etiology , Cystic Duct/pathology , Diagnosis, Differential , Female , Follow-Up Studies , Hepatic Duct, Common/pathology , Humans , Male , Middle Aged , Retrospective Studies , Syndrome , Time Factors , Treatment OutcomeABSTRACT
Results of pre-, intra and postoperative diagnosis of the Mirizzi syndrome were analyzed in 29 patients. The most effective method of preoperative diagnostics was found to be magnetic resonance cholangiography. The "gold standard" of intraoperative diagnostics of the Mirizzi syndrome is cholangiography.
