THERAPEUTIC STRATEGY
There is no consensus regarding the treatment of cholangitis ....
> Although it is widely regarded as the ideal treatment is based on laparoscopic surgery at a time, including cholecystectomy, intraoperative cholangiography and stone extraction. In this situation, so there is no room for endoscopic treatment.
> However, in centers where surgeons are experienced in the practice of comprehensive treatment of cholangitis in laparoscopy, cholecystectomy is performed only by laparoscopy, and treated the calculations of the VBP by endoscopy.
Several choices are possible:
- Either we make the first endoscopic approach, possibly including sphincterotomy, with its risks (morbidity of 8 to 10% and mortality of 0.2% on average, up 1.5% for oddienne complication) and a failure rate of about 4 to 6%, followed by laparoscopic cholecystectomy.
- Or, and this seems preferable, it begins with laparoscopic cholecystectomy with placement of a transcystic drain, secondarily, a cholangiogram is performed by the drain and the presence of the calculation has been confirmed, we slide a wire - guide the drain to conduct endoscopic sphincterotomy with minimal risk. In this protocol, the success rate is close to 100%.
Complications of sphincterotomy are represented mostly by acute pancreatitis (early pancreatic purely biological reaction to a pancreatic reaction requiring several days of hospitalization, or to severe forms with a very serious risk of death), followed by the bleeding and fewer duodenal perforation, peri-ampullary, retroperitoneal.
> A final indication of the endoscopic approach arises when the surgery was originally scheduled to be complete in time, is in check because of the excessive size of the calculation or the presence of a duodenal diverticulum or peri-choledochal of treatment failure of the bile duct. In this case, after cholecystectomy, transcystic drain is allowed and the following week, the endoscopist will complete the surgery.
If cons-indication for surgery, it is limited to the endoscopic treatment, leaving the gallbladder in place.
> Finally, surgery by treaty will be the only indication to the inability or failure of laparoscopic and endoscopic techniques.
> Surgery by treaty will be the only indication to the inability or failure of laparoscopic and endoscopic techniques.
> Although it is widely regarded as the ideal treatment is based on laparoscopic surgery at a time, including cholecystectomy, intraoperative cholangiography and stone extraction. In this situation, so there is no room for endoscopic treatment.
> However, in centers where surgeons are experienced in the practice of comprehensive treatment of cholangitis in laparoscopy, cholecystectomy is performed only by laparoscopy, and treated the calculations of the VBP by endoscopy.
Several choices are possible:
- Either we make the first endoscopic approach, possibly including sphincterotomy, with its risks (morbidity of 8 to 10% and mortality of 0.2% on average, up 1.5% for oddienne complication) and a failure rate of about 4 to 6%, followed by laparoscopic cholecystectomy.
- Or, and this seems preferable, it begins with laparoscopic cholecystectomy with placement of a transcystic drain, secondarily, a cholangiogram is performed by the drain and the presence of the calculation has been confirmed, we slide a wire - guide the drain to conduct endoscopic sphincterotomy with minimal risk. In this protocol, the success rate is close to 100%.
Complications of sphincterotomy are represented mostly by acute pancreatitis (early pancreatic purely biological reaction to a pancreatic reaction requiring several days of hospitalization, or to severe forms with a very serious risk of death), followed by the bleeding and fewer duodenal perforation, peri-ampullary, retroperitoneal.
> A final indication of the endoscopic approach arises when the surgery was originally scheduled to be complete in time, is in check because of the excessive size of the calculation or the presence of a duodenal diverticulum or peri-choledochal of treatment failure of the bile duct. In this case, after cholecystectomy, transcystic drain is allowed and the following week, the endoscopist will complete the surgery.
If cons-indication for surgery, it is limited to the endoscopic treatment, leaving the gallbladder in place.
> Finally, surgery by treaty will be the only indication to the inability or failure of laparoscopic and endoscopic techniques.
> Surgery by treaty will be the only indication to the inability or failure of laparoscopic and endoscopic techniques.
09:12
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