Biliary drainage after laparoendoscopic interventions in acute cholangitis

Aim. The aim of this study was to evaluate the advantages and disadvantages of primary choledochal suture and various types of drainage after laparoendoscopic surgery for choledocholithiasis in patients with not severe acute cholangitis. Materials and methods. A retrospective cohort study was conducted based on data from 104 case of treatment of patients with mild to moderate acute cholangitis treated at the Research Institute of Emergency Medicine named after. I.I. Dzhanelidze in the period from 2016 to 2021. Patients were divided into 4 groups: with primary suture of the common bile duct, decompression with T-tube, through the cystic duct and with the plastic stents. Results. There were no significant differences in gender, age, comorbidity index in the studied groups. There were also no statistical differences in the effectiveness and duration of interventions. Postoperative hospital stay was significantly shorter in the cystic duct drainage group than in the primary suture group. (p = 0.017). Differences in the cost of treatment between the groups of T-tube, transcystic and stenting were statistically significant (p = 0.044, p = 0.012). The incidence of postoperative complications specific to the biliary tract was 7.4% (2/27 cases) in the T-tube drainage group, 4.7% (2/43 cases) in the transcystic group, 15.4% (2/13 cases) in the stent group and 11.1% (3/27 cases) in the group of primary closure. Conclusion. It is possible to refuse drainage of the bile ducts after lithoextraction in patients with non-severe acute cholangitis. Drainage of the common bile duct through the cystic duct allows to achieve the least number of complications and reduce the postoperative hospital stay. The use of antegrade stenting eliminates the need for external drainage, but is associated with the highest costs for the healthcare system.