APPLICATION OF THE CLOSED SUTURE OF THE BILE DUCT IN THE TREATMENT OF COMPLEX CHOLEDOCHOLITHIASIS IN ELDERLY AND SENILE PATIENTS
Abstract
Choledocholithiasis is one of the leading complications of cholelithiasis. The long course of this disease can lead to the formation of large and/or hard-to-reach stones in the bile ducts. National and foreign authors combine such cases into the concept of “complex choledocholithiasis.” Despite the widespread introduction of minimally invasive interventions, the issue of choosing surgical tactics for the treatment of complex choledocholithiasis in elderly and senile patients is still relevant today. The objective reason for the differential approach in this group of patients is the presence of concomitant pathology, which pushes the surgeon to search for a faster and more effective surgical intervention that will provide a cure in a short time. The article describes the method of using the closed suture of the common bile duct in the treatment of complex choledocholithiasis in elderly and senile patients. The effectiveness of surgical treatment of 171 patients was analyzed for the period from 2009 to 2022. In the study, all patients (100%) underwent intraoperative fibrocholedochoscopy, which made it possible to detect the anatomical features of the bile ducts, assess the patency of the common bile duct, identify hard-to-reach stones in the ducts and, if necessary, remove them using grasping devices. Videoscopy eliminated the need for fistulography and made it possible to confirm a complete revision of the biliary tree. The next step was to form the closed suture of the common bile duct according to the proposed method. The results of treatment noted a decrease in the level of intra- and postoperative complications, mortality, and a decrease in the period of hospital stay of patients. The data obtained indicate the effectiveness of the proposed surgical method for treating complex choledocholithiasis in a group of elderly and senile patients.
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