СLINICAL AND LABORATORY CHARACTERISTICS OF LOWER EXTREMITY ARTERIAL DISEASE IN THE CONDITIONS OF COMORBIDITY
DOI:
https://doi.org/10.32782/health-2025.4.8Keywords:
сholedocholithiasis, laparoscopic cholecystectomy, endoscopic retrograde cholangiopancreatography, laparoscopic bile duct exploration, single-stage treatment.Abstract
This article provides a comprehensive overview of modern minimally invasive strategies for managing patients with concomitant cholecysto-choledocholithiasis and critically evaluates the effectiveness of the two main treatment approaches: two-stage management (preoperative ERCP followed by laparoscopic cholecystectomy) and single-stage procedures (laparoscopic cholecystectomy combined with laparoscopic bile duct exploration or intraoperative ERCP). Although the traditional two-stage strategy remains widely used, it carries several significant disadvantages, such as high rates of unnecessary or negative ERCP, risk of incomplete duct clearance, increased postoperative complications, prolonged treatment duration, and the need for repeated hospitalizations. Delayed cholecystectomy after ERCP is associated with a markedly higher incidence of recurrent biliary events. Alternative minimally invasive options, including laparoscopic bile duct exploration (transcystic and choledochotomy approaches) and different techniques of intraoperative ERCP, such as standard, modified, and rendez-vous procedures, are reviewed in detail. Their technical aspects, advantages, and limitations are analyzed. Comparative studies evaluating choledochoscopy versus fluoroscopy are summarized, as well as the three main methods of closing a choledochotomy–T-tube drainage, biliary stenting, or primary closure. Evidence suggests that primary closure often results in fewer complications, shorter operative time, and reduced hospital stay compared with conventional T-tube drainage. Special attention is given to technical nuances of intraoperative ERCP, including the use of antegrade guidewire placement and right-sided access, which help reduce the risk of post-procedure pancreatitis. Contemporary data regarding the safety, efficacy, and practicality of various minimally invasive interventions are synthesized, supporting personalized treatment selection based on clinical condition, surgeon expertise, and institutional capabilities.
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