Kotovshikov M. Evaluation of life quality and long-term results of surgical treatment of patients with choledocholithiasis

The aim of the study was to improve the results of surgical treatment of patients with gallstone disease, complicated by choledocholithiasis, based on individualization of the choice of the method of restoring of the bile outflow, by taking into account the life quality of patients in the long-term period. The work is based on the analysis of the results of surgical treatment of 293 patients with gallstone disease, complicated by choledocholithiasis. The age of patients was ranged from 18 to 83 years, with an average age of 58.1 ± 0.8 years. Depending on the method of restoring of the bile outflow, patients were divided into 3 groups. 1st group consisted of 110 (37.5%) patients after cholecystectomy with choledochoduodenostomy (CDS); 2nd group - 80 (27.3%) patients after cholecystectomy (CE) and transduodenal papillosphincteroplasty (TDPSP); 3rd group included 103 (35.2%) patients who after endoscopic papillosphincterotomy (EPST) followed by laparoscopic cholecystectomy. The development of postoperative pancreatitis was the most frequent complication, significantly higher after TDPSP. Functional liver tests revealed the signs of liver cell damage and disruption of homeostasis. Morphological changes of the liver were manifested in the form of severe processes of necrosis and sclerosis, as a parenchymal protein and focal adipose tissue distrophy; as a lymphoid-histiocytic infiltrates in periportal connective tissue; as a sharp enlargement and thickening of arteries, veins, bile ducts in the triad region; as a spreading of connective tissue on the interlobular connective tissue capsule. Evaluation of the condition of biliodigestive anastomoses and extrahepatic bile ducts in the long-term periods revealed the chronic inflammatory changes of the structure, sclerotic changes were more common in patients after the CDS, and depended on the method of restoring of the bile outflow. The differences, directly related to a type of surgical intervention, were found in the indicators of quality of life. It has been found that the best method of surgical treatment of patients with choledocholithiasis is endoscopic pancreatic sphincterotomy (EPST). If there are contraindications to this surgical intervention, the optimal choice of the method of treatment of patients is carried out by taking into account the data of possible early and long-term complications and indicators of the life quality of patients