Duct stones without cut
After cannulation of the duct and contrast (ERCP), dissection of the sphincter opens the exit for the stones: small ones are removed immediately, large ones are pre-fragmented with a mechanical lithotripter. Jaundice and cholangitis resolve in the first days; In case of inflammation, a nasobiliary drainage or stent is temporarily left in place. After 2–4 weeks, laparoscopic cholecystectomy is performed - the source of the stones is eliminated. The risks of the method (pancreatitis 3–5%, bleeding) are minimized by technique and prevention; The procedure is performed by the X-ray endoscopic team.
Indications
- stones of the common bile duct (choledocholithiasis) with jaundice, cholangitis, pancreatitis;
- obstructive jaundice due to tumors of the head of the pancreas, ducts, and porta hepatis;
- duct strictures, the need for their drainage and prosthetics;
- preparation for radical surgery or palliative bile diversion.
Minimally invasive duct treatment
Duct stones and obstructive jaundice are today treated without large incisions: retrograde through the duodenum (endoscopic papillosphincterotomy with lithotripsy and stone extraction) or antegrade through the skin and liver (percutaneous transhepatic cholangiostomy with drainage and stenting of the ducts under ultrasound/X-ray control). The choice depends on the level and cause of the block, the anatomy and condition of the patient; The techniques complement each other and are often combined with subsequent cholecystectomy or radical surgery.
Benefits of laparoscopy
Laparoscopic access is the standard of modern abdominal surgery: instead of a 10–20 cm incision, 3–4 punctures are left, the pain after surgery is much less, the patient gets up on the day of surgery and is discharged after 1–2 days, the risk of wound infection, hernias in the scar and adhesions is several times lower, and the enlargement of the camera allows you to operate more accurately. In the clinics below, operations are performed by surgeons with extensive laparoscopic experience; hospital (SKD) is included in the price according to the price list.
