Shapovalova K. Balloon dilation of the major duodenal papilla in the treatment of choledocholithiasis (experimentally - clinical researches)

The aim of dissertation is to increas the effectiveness of treatment of patients with choledocholithiasis by developing and implementing improved methods of balloon dilatation of the major duodenal papilla (MDP) during endoscopic and laparoscopic operations. The long-term results of treatment of 145 patients with choledocholithiasis have been analyzed. On the basis of comparison of the results of laparoscopic methods, it is proved that the combination of laparoscopic cholecystectomy with balloon dilatation of MDP is characterized by a less on 20% (63 % vs. 80 %) (p?0,05) frequency of relapses of concrements and stenoses in the postoperative period compared with a group of laparoscopic cholecystectomy without balloon dilatation of MDP. Balloon dilatation of MDP avoids 2-stage treatment of choledocholithiasis, prevents the occurrence of postoperative biliary hypertension, preserves the physiological passage of bile into the duodenum, preserves the integrity of the sphincter apparatus of the MDP and does not result in the development of acute pancreatitis. Significant advantages of the method of dosage EPST with balloon dilation were revealed in comparison with the full EPST: bleeding after EPST was less (26.1% vs. 6.6 %, p <0.05); remote postoperative complications were observed 3 times less frequently (16.7 % vs. 50 %, p <0.05); the efficiency of one-step removal of concrements was 50 % vs. 83.3 % (p <0.01). The use of advanced balloon dilatation techniques avoids intraoperative perforation and postoperative failure of a large duodenal nipple.