Minimally invasive methods of biliary decompression in patients with obstructive jaundice

Annotation. Today, both one-stage and multi-stage minimally invasive surgical interventions are used in biliary surgery. However, the criteria for selecting different methods of biliary decompression for treatment of obstructive jaundice (OJ) remain uncertain. The aim – assessment of the effectiveness of using one-stage and multi-stage minimally invasive methods of bile duct decompression in patients with OJ. We analyzed the results of surgical treatment of 160 patients with OJ who underwent minimally invasive interventions. The average age was 50±6.0 years. The average duration of OJ was 18±3.5 days. One-stage minimally invasive surgical interventions were used in 50 (31.2%) patients and two-stage minimally invasive interventions in 110 (68.8%). One-stage interventions included laparoscopic cholecystectomy (LCE) with cysticolithotomy, external drainage of the bile ducts. Two-stage tactics involved endoscopic transpapillary interventions at the first stage and LCE at the second stage. One-stage correction of bile duct obstruction is recommended for patients with bilirubin count below 200 μM/l, OJ duration up to 2 weeks, compensated or subcompensated concomitant pathology, and no complications. Priority is given to two-stage surgical tactics for treatment of OJ patients with hyperbilirubinemia over 200 μM/l, OJ duration over 2 weeks, the presence of comorbidities in the stage of decompensation, and concomitant acute cholangitis and biliary pancreatitis.