WAYS TO IMPROVE THE RESULTS OF TREATMENT OF PATIENTS WITH CHOLELITHIASIS AND MECHANICAL JAUNDICE.

Purpose. To create a personalized tactic of surgical treatment of patients with BSD and MJ considering the stage of the pathological process and thereby improve the results of treatment. Materials and methods. The experience of diagnosis and treatment of 537 patients with complications of cholelithiasis, manifested by mechanical jaundice, was analyzed. The first stage was 537 minimally invasive decompressions of the biliary tract, the second-500 different types of endosurgical interventions. Results. Depending on the tactical principles, all the subjects were divided into two groups. In one (control) group (n = 249), patients were admitted from 2010 to 2014. Their treatment was empirical: decompression of the bile tree was performed at different times, and surgery was performed without taking into account the stages of the pathological process and the severity of the patients. In the other analyzed group (n = 251), patients were admitted to the hospital from 2015 to 2019. Their treatment tactics were personalized: taking into account the stages of mechanical jaundice. individual terms of decompression of the bile ducts and the choice of surgical intervention were determined. When comparing the results obtained, the advantage of the personalized approach was established: a decrease in the percentage of postoperative complications and mortality was revealed. Conclusion. In patients with cholelithiasis and jaundice, the severity of the condition is due to hyperbilirubinemia. Stage 2 of mechanical jaundice-determined by the severity of cytolysis in hepatic insufficiency, manifested by hypertransaminasemia. The severity of cholangitis is determined by purulent-inflammatory, as well as septic signs of the disease, characterized by leukocytosis, circulating immune complexes and medium-weight molecules. In the cholestatic stage of jaundice development, treatment is planned, in the cytolytic stage — urgent, and in cholangitis-emergency. The use of personalized tactics for the treatment of patients with breast cancer has reduced the number of complications and mortality.

Interventional radiology techniques in the treatment of cholangiolithiasis: indications, efficacy, accessibility

Our days, the problem of treating complicated forms of cholelithiasis continues to be relevant despite the undoubted successes in the field of hepatobiliary surgery. Cholangiolithiasis is one of the most frequent and dangerous complications of cholelithiasis, it is detected in 8–26 % of patients with cholelithiasis. In some cases, it is impossible to perform an endoscopic retrograde method, these special situations require the development of new original minimally invasive methods for resolving cholangiolithiasis, which have all the advantages of «small access». The analysis of the treatment of 466 operated patients with cholelithiasis complicated by cholangiolithiasis and mechanical jaundice in the period from 2013 to 2019 was carried out. The patients were divided into 3 groups: 1 — the endoscopic retrograde method was used (n = 369), 2 — laparotomic access (n = 26), 3 — antegrade X-ray interventional method (n = 71). The results obtained allow us to conclude that the antegrade interventional radiology technique for the treatment of choledocholithiasis has a high clinical efficacy comparable to the endoscopic technique. The use of this treatment option avoids traumatic laparotomies and open interventions on the bile ducts. The use of method is justified in cases of impossibility of performing endoscopic intervention, or its ineffectiveness.

A Study on Bacterial Etiology of Cholecystitis due to Gallstones and their Antimicrobial Susceptibility Pattern in A Tertiary Care Hospital

Cholelithiasis is a very common condition affecting the Gallbladder. Gallstones are present in 10 -15 % of the adult population. Females are three times more likely to develop Gallstones than male. Gall stones are classified into cholesterol and pigment stone. About 80% of them are cholesterol stone and 15-20% pigment stone. Obstruction and infections are the common complications of Cholelithiasis. Approximately 1-2% of the patients become symptomatic and warrants cholecystectomy (1). With this background we conducted a cross sectional study in the Institute of Microbiology, MMC & RGGGH, for 72 consecutive patients who underwent cholecystectomy. The most common age group affected 41-60 yrs. The most common symptoms are abdominal pain, dyspepsia and Jaundice. In this study Gallstones are collected after surgery, processed and Antibiogram pattern also studied as per standard guidelines. Out of 72 samples studied 35 (48.6%) are culture positive. Escherichia coli is the predominant organism isolated followed by Klebsiella pneumonia(52). Most of the isolates were sensitive to commonly used antibiotics for Gram Negative bacilli.

A rare complication of cholecystolithiasis: perforation of the gallbladder

Common complications of cholelithiasis include gallbladder inflammation, cholangitis, and acute pancreatitis. On the other hand, rare complications include gallbladder carcinoma, gallstone ileus, Mirizzi syndrome and gallbladder perforation. Some patients with cholecystitis do not require hospitalization. It is of key importance for proper further diagnosis and treatment to remember about the possible complications of cholecystitis, especially in oligosymptomatic patients. Therefore, ultrasound examinations in patients with a history of gallbladder stones should be performed with appropriate care. Ultrasound should be performed carefully in patients with a history of cholecystolithiasis, especially those oligosymptomatic, bearing in mind that there are some rare complications of this highly common clinical entity.

Features of the clinic in patients with non-tumor mechanical jaundice with concomitant pathology

The Objective was to improve the results of diagnostics of the severity of patients with complications of cholelithiasis, occurring in the form of mechanical jaundice, against the background of comorbidity.Methods and Materials. 537 patients admitted in the clinic of hospital surgery of Kabardino-Balkar State University named after H. M. Berbekov in the period from 2010 to 2019 were examined. The terms of admission to the hospital were different. 25 (4.6 %) people were admitted in a short period of time up to 6 hours. A day after the onset of the disease – 82 (15.3 %) people. More than half – 277 (51.6 %) people were hospitalized a week after the onset of the disease. We analyzed the data of comorbidity scales of CIRS, Kaplan–Feinstein and Mary Charlson Index, as well as biochemical criteria reflecting the severity of calculous cholecystitis, jaundice and concomitant diseases.Results. As a result of their analysis and comparison, we found that comorbidity in patients of this kind is the main aggravating factor and worsens the пeneral condition as the stages of jaundice develop.Conclusion. We found out that a common biochemical tests as for characterizing changes of the hepatocyte in nontumor obstructive jaundice, and for evaluating the degree of impact of comorbidity are the content of blood alkaline phosphatase, creatine phosphokinase and transaminases. Intoxication syndrome in patients with cholangitis and comorbidity so negatively affect all organs and systems of the body that it can lead to inoperability.

Features of mechanical jaundice course caused by complications of bile disease

The OBJECTIVE was improving the results of diagnostics and assessment of the severity of patients with mechanical jaundice (MJ) at various stages of its development.METHODS AND MATERIALS. The basis of clinical and laboratory research was the data of 537 patients who were admitted during the period from 2010 to 2019. Principles of separation at the stage of the course of mechanical jaundice of non-tumor Genesis.RESULTS. Analysis of clinical and laboratory studies showed characteristic signs of various complications of cholelithiasis, accompanied by mechanical jaundice. Then, on this basis, specific symptoms characteristic of each stage of mechanical jaundice of non-tumor Genesis were determined.CONCLUSION. The course of mechanical jaundice, which develops with complications of cholelithiasis, has a phase-stage character, beginning with extrahepatic cholestasis, then-joining hepatocytolysis and ending with cholangitis. Initially, cholestasis and cytolysis are functional, which is confirmed by biochemical tests, so these processes are labile and reversible. This makes it possible to effectively use biliary decompression methods and infusion therapy with detoxification during treatment. Cholangitis is characterized by destructive morphological manifestations, so it is verified by specific clinical symptoms and laboratory tests characteristic of inflammatory-septic reactions and progresses to sepsis. Differentiation of stages of mechanical jaundice allows to personify surgical and conservative treatment of such patients.

Erodes and bleeds, fistulises and obstructs: Bouveret’s syndrome

One of the rare complications of cholelithiasis is gallstone ileus which occurs in <5% of patients. Among them, <3% develop Bouveret’s syndrome: gastric outlet obstruction by a large gallstone in the pylorus or duodenum. One large review of 128 patients showed it to present at a mean age of 74.1 ± 11.1 years with a mean gallstone size of 4.6 ± 1.5 cm, with nausea or vomiting in 86%, abdominal pain in 71% and haematemesis in 15%. The diagnosis is usually clear on oesophagogastroduodenoscopy or abdominal contrast-enhanced computed tomography. We present a case with massive upper gastrointestinal bleeding, due to erosion of a cystic artery pseudoaneurysm.

Minimally invasive interventions in the treatment of patients with cholelithiasis complicated by obstructive jaundice

One of the most threatening complications of cholelithiasis (cholelithiasis) is obstructive jaundice (MF), which leads to the development of hepatic-renal failure. The results of surgical treatment of 386 patients were analyzed for various forms of cholelithiasis complicated by breast. The use of a combination of ultrasound, endoscopic, and radiation studies in the diagnostic program to visualize the cause of the mammary gland against the background of the complicated course of the cholelithiasis made it possible in almost 100 % of cases to make a correct diagnosis and conduct a staged minimally invasive surgical treatment: stage I included endoscopic retrograde cholangiopancreatography, papillosphincterotomy with choledocholithotraction, debridement and nasobiliary drainage of the common bile duct; at the II stage, 83,94 % of patients underwent laparoscopic cholecystectomy. The tactics of widespread use of a combination of highly informative diagnostic methods and staged minimally invasive treatment is characterized by high efficiency and good results.