Prevention of the liver failure development through decompensation of the biliary system in patients with obstructive jaundice by performing minimally invasive laparoscopic

Abstract

The effectiveness of the two-step method of treatment of patients with mechanical jaundice (MJ) focusing on the liver functional state during the postoperative period was assessed. Endoscopic papillosphincterotomy (EPSP) was done in 98 (59.8%) patients, 88 cases of them (53.7%) were due to choledocholithiasis. EPSP was finished by lithextraction in 59 patients (66.0%), by mechanical lithothrypsy – in 29 patients (17.7%). Laparoscopic cholecystectomy was done to all 98 patients 1–5 days after the EPST and to all patients in the 1st group. Surgical intervention was started laparoscopically; conversion was done in 25 patients. There were 6 cases of complications (5.9%) among the patients of 1st group which were eliminated during the postoperative period. All patients were alive at the time of 3 months after surgery. Clinical and laboratory checking confirmed the satisfactory level of liver functioning. Only 2 patients had transient hyperamylasemia. There were 12 cases (19.0%) of complications in patients of the 2nd group that was higher compared to the same index in the 1st group patients (p<,01). The clinical indexes of hepatic insufficiency development were present in 9 patients (14.3%) of the 2nd group that was also greater compared to group 1 (p<,01). According to these data the authors recommend an individual approach to the selection of surgical treatment in each case, the operative interventions performed in the so-called “cold period”, as well as obvious analysis of possible high operational and anaesthetic risk including the patient’s age. The stages of surgical intervention in patients with obstructive jaundice and choledocholythiasis are the priority method of effective surgical treatment. The laparoscopic, but not open cholecystectomy performing at the second stage of treatment, prevents hepatic insufficiency formation in patients throughout the postoperative period.