Karel O. Diagnostics and transpapillary technologies of treatment of patients with biliary pancreatitis and suppurative cholangitis

Dissertation is aimed at improvement of treatment results of patients with choledocholithiasis, complicated by cholangitis and biliary pancreatitis by improving endoscopic papillary surgical methods. The negative impact of contrast cholangiography on the severity of hepatodepressive and hepatocytolytic syndromes in patients with choledocholithiasis complicated by cholangitis and biliary pancreatitis was established. The feasibility, safety and effectiveness of endoscopic technologies without prior cholangiography in the treatment of patients with choledocholithiasis complicated by cholangitis and biliary pancreatitis have been proven. The pathogenesis and dynamics of hepatodepressive and hepatocytolytic syndromes in patients with choledocholithiasis complicated by cholangitis and biliary pancreatitis were studied for the first time during their surgical treatment using minimally invasive technologies. The obtained results deepen and clarify the data on the pathogenesis of hepatocellular insufficiency in patients with complicated choledocholithiasis. Under conditions of cholangitis and biliary pancreatitis, hepatodepressive and hepatocytolytic syndrome is formed, which is exacerbated by retrograde endoscopic transpapillary cholangiography. The results of research expand the knowledge about the causes of possible complications of endoscopic transpapillary surgery in complicated choledocholithiasis. As a result of scientific research, a method of transpapillary surgical interventions for choledocholithiasis complicated by cholangitis and biliary pancreatitis, without prior cholangiography, has been developed. An algorithm for transpapillary surgery without prior cholangiography has been developed. A method of treatment of biliary pancreatitis has been patented and introduced (patent № 141268) which provides endoscopic intervention without prior ERCG, and a method of treatment of suppurative cholangitis with biliary sepsis (patent № 141544), which involves endoscopic intervention without prior ERCG.