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Objectives: The high recurrence rate of cholecystolithiasis (20-40%) post cholecystolithotomy forced to delve into understanding of its causes. The use of endoscopic revision of the gallbladder (GB) cavity allowed to diagnose small immobile stones and polyps in the folds of the mucosa. A number of experts consider them to be factors for recurrence of cholecystolithiasis after the removal of mobile formed stones only.
Purpose: to develop a technology of laparo-endoscopic cholecystolithotomy in the uncomplicated cases of cholecystolithiasis.
Materials and methods: A retrospective analysis of the results of laparoscopic cholecystolithotomy in 46 patients for the period of 2007 to 2012 was performed. A prospective analysis of the results of laparoscopic endoscopically assisted cholecystolithotomy developed in 74 patients for the period of 2013 to 2018 was performed. There were 14 (18.9%) males and 60 (81.1%) females, ages 21-70 (36.4±4.2). The attention was focused on the establishment of the cause-and-effect factor in cholecystolithiasis development. The selection criterion included patients with uncomplicated symptomatic and asymptomatic cholecystolithiasis. The main selection criterion was sonography, with the definition of structure, signs of active inflammation and motility function of GB. Post-surgical rehabilitation program was used to prevent the recurrence of cholecystolithiasis.
Results: According to the prospective analysis the number of removed gallstones ranged from 1 to 5. Their size ranged from 9-33 (18.7±3.5) mm. In 16 cases, after lithextraction, at the endoscopic examination of the GB cavity, small gallstones and mucus in the folds of the mucosa were diagnosed, which were removed by additional rinsing. In 8 cases, except for the lithextraction, GB polyps were removed, in the size of 3-6 mm. The surgical intervention lasted 55-130 (84.40±18.56) min. The recurrence of cholecystolithiasis with a retrospective analysis in terms of observation up to 10 years was diagnosed in 26.0%, and in a prospective analysis in terms of observation up to 5 years - in 4.1% cases.
Conclusions: Laparo-endoscopic cholecystolithotomy technology is an optimal treatment modality for the uncomplicated cases of cholecystolithiasis which allows not only endoscopic control, but also the removal of mucоsa fixed concrements and polyps undiagnosed by ultrasound, which reduces cholecystolithiasis recurrence by 6.3 times (from 26.0% to 4.1%, p < 0.01).