Vovk V. Optimization of surgical treatment of cholangitis and its complications

The thesis contains theoretical justification and practical solution of the scientific problem - improving the results of surgical treatment of cholangitis and its complications. In the dissertation the results of research of 319 patients with various etiology cholangitis and complications of cholangitis are presented. As a result of the work, new aspects of the pathogenesis of development of acute cholangitis associated with changes in the concentration of bile acids in bile have been identified. Inflammatory processes contribute to major bile ducts cytotoxic concentrations of hydrophobic bile acids in bile biliary tree that have damaging effects on the epithelium of the bile ducts. As a result of the exudation of the duct epithelium of the inflammatory fluid and the reduction of bile acid hepatocyte secretion, their concentrations in the duct is sharply reduced. Due to the decrease in the concentration of bile acids, the antimicrobial properties of the bile disappear, and there is infection of the bile in the lumen of the biliary ducts. The infectious inflammatory ductal process immediately becomes purulent in condition of increased intraductal pressure. Based on morphological and biological studies it is proven that the optimal timing for operations on the gall bladder and hepatoduodenal ligament within surgical staged treatment is a period of up to 7 days or after 18 days after endoscopic transpapillary interventions to eliminate obstruction bile outflow. According to the results of the comprehensive analysis of treatment of patients with cholangitis, the methods of using minimally invasive surgical intervention in obstruction of the distal part of the common bile duct, Mirizzi syndrome, post-interventional complications from the pancreas, parapapillary ulcers and liver abscesses using combined endoscopic, x-ray, and laparoscopic approaches have been developed. As a result of the introduction of developed methods of surgical treatment of patients with violation of the patency of the biliary tract of various etiology, reduction of postoperative complications from 23.4% to 9.2% was achieved. The application of developed surgical approaches contributed to the reduction of postoperative lethality in patients with cholangitis and complications of cholangitis from 12.0% to 5.9%. Key words: cholangitis, complications, pathogenesis of cholangitis, minimally invasive interventions, liver abscess.