Zosym V. Miniinvasive surgery in patients with choledocholithiasis.

Dissertation concerns surgical treatment of patients with acute and chronic calculous cholecystitis, complicated by choledocholithiasis, using modern and advanced diagnostic options and miniinvasive surgical treatment. It is proved that endoscopic ultrasonography has a lot of advantages compared to the routine one (diagnostic accuracy of hepaticocholedochus stones is 97.2% versus 28.8% using routine US) and does not depend on cholecystitis type, choledochus diameter and stones. Choledocholithiasis diagnostic algorithm in acute and chronic cholecystitis patients was elaborated. In the dissertation one and two-steps approach to stones extraction was evaluated. Thus, one-step miniinvasive choledochus stones extraction (via d. cysticus or choledochotomy approach during laparoscopic cholecystectomy) is more perspective than two-steps (papyllosphyncterotomy, followed by laparoscopic cholecystectomy or laparoscopic cholecystectomy, followed by papyllosphynctero-tomy): papilla duodeni function preservation, nopapyllosphyncterotomy-related complications (versus 9.8% cases of two-steps approach).