DIAGNOSTIC PROGRAM AND SURGICAL TACTICS WITH BILE LEAKAGE AFTER LAPAROSCOPIC CHOLECYSTECTOMY

In this study, the analysis of surgical treatment results of 10576 patients with cholelithiasis, who underwent laparoscopic cholecystectomy (LC), was performed. The aim of the study was to improve results of surgical treatment of patients with cholelithiasis, who had external or internal bile leakage (BL), by optimization and improvement of diagnostic program and surgical tactic of minimally invasive techniques usage. Early post-operative period 63 (0,6%) patients had BL. 51 (81,0%) of them were women, 12 (19,0%) were men. Average age was 57,6 ± 8,1 years old. 21 (33,3%) patients underwent LC due to chronic cholecystitis, 42 (66,7%) patients had acute cholecystitis. In 51 (81,0%) cases there was drainage bile leakage, in 12 (19,0%) cases bile collection in abdominal cavity was identi-fied several days after drains ejection, due to clinical manifestation and ultrasonography data. Developed surgical tactic, which is based on ultraso-nography and ERCP data, allows to improve treatment results and to avoid septic complications and lethal cases. 22 (34,9%) patients were treated conservatively. Minimally invasive endoscopic manipulations, ultrasonography controlled percutaneous drainage and relaparotomy were effective in 32 (50,8%) patients, 9 (14,3%) patients underwent laparotomy with following surgical correction of BL. These patients had dense perivesical infiltrates, Mirizzi's syndrome type I. 5 (7,9%) patients underwent laparotomy, abdominal cavity sanation and drainage. In 1 (2,1%) case partial right bile duct injury was identified, defect suturing and Vishnevsky common bile duct drainage. In 2 (3,8%) cases the cause of BL was more than 2/3 diameter injury of common bile duct. These patients underwent Roux-en-Y hepaticojejunostomy.