Tkachenko O. Minimally invasive operative interventions in the pathology of the bile ducts

In the study presented are the results for clinical trial of 765 patients with bile duct pathology, as choledocholithiasis and obstructive jaundice, using minimally invasive operative procedures. The aim of the work was to improve modern concepts of treatment of patients with choledocholithiasis and obstructive jaundice of the bile ducts. Conducted randomized clinical trials are based on the recommendations of the European Association for Endoscopic Surgery (E.A.ES). Scientific evidence, the possibility of limiting 47,8% of indications for external drainage of the bile ducts, thanks to the developed algorithm and implementation of original patented technique of antegrade stenting, which reduces the number of postoperative complications and the average length of hospital stay by 1.8 times. We have studied and classified the blood system and its hemocoagultory changes in patients with choledocholithiasis and obstructive jaundice, to identify possible correction of violations minimally invasive surgery. It was found that changes in the hemostatic system and their dynamics in obstructive biliary tract obstruction have different directions, depending on the severity of jaundice. Timely prevention of these violations can prevent hematological complications. Studied the long-term results of surgical treatment of patients with choledocholithiasis and revealed the advantages of laparoscopic methods for removing stones compared with endoscopic. Since EPO after 13.3% of cases develop recurrent cholangitis due to the reflux of duodenal contents into the bile ducts. In this work we developed scientifically substantiated new concept and approach of optimal choice of minimally invasive methods of extraction of bile duct stones - a balanced combination of minimally invasive endoscopic and laparoscopic techniques. The choice of method should be based on the anatomy of the bile ducts, the number, size and location of stones, inflammatory changes in the gallbladder and ducts, patient age, hospital equipment.