INCREASING THE EFFECTIVENESS OF SURGICAL TREATMENT OF CHOLEDOCHOLITHIOSIS IN PATIENTS WITH CHOLANGITIS

Аннотация

The article addresses the optimization of surgical treatment methods for choledocholithiasis complicated by purulent cholangitis. Given the rising prevalence of cholelithiasis and its serious complications, particularly in industrialized countries, the study focuses on improving outcomes through advanced surgical strategies. A total of 70 patients were analyzed at the Andijan State Medical Institute from 2023 to 2024. Traditional and modified multi-stage surgical approaches were compared, including open and laparoscopic cholecystectomy, choledocholithotomy, endoscopic papillosphincterotomy (EPST), and nasobiliary drainage. Results showed that the improved method, which combines minimally invasive surgery with intraportal antibiotic administration and bile duct lavage, significantly reduced the incidence ofsevere complications such as liver microabscesses and sepsis. The study concludes that early diagnosis and a tailored surgical approach enhance the effectiveness of treatment and reduce mortality inpatients with complicated choledocholithiasis. Relevance. The prevalence of cholelithiasis, which affects 10-15% of men and has increased to 25%in women in industrialized countries, makes this pathology an urgent public health issue [1]. It is considered the primary cause of acute cholecystitis and associated complications in the vast majority of cases (95%), which emphasizes its importance. There are various opinions regarding the surgical strategy, especially in the acute phase of the disease. However, the widespread perception of acute cholecystitis as the only complication does not reflect the complexity of the picture: the disease can affect the complex "gall bladder - ducts - subgastric cholecystitis", causing a variety of disorders [7]. The key treatment method for purulent cholangitis is early surgical intervention aimed at external decompression of the biliary ducts using drains and removal of stones from the common duct [2]. This approach ensures the removal of infected biliary ducts, significantly reducing the degree of mechanical damage and toxic effects on the body. However, traditional passive decompression leads to a sharp, unpredictable drop in pressure in the ducts, which leads to blockage of small channels with impaired biliary duct outflow and the formation of liver microabscesses. These local infections can subsequently grow into large abscesses [5]. There are various approaches to antibacterial treatment: some specialists [3] prefer to administer antibiotics before, during and after duct drainage surgery with periodic (every 5-8 days) drug changes in combination with metronidazole. The second group of researchers [1] supplements antibiotic therapy with sodium hypochlorite infusions, its endobiliary use and low-energy laser exposuretothe liver. They also usesodium chloride solution with ozoneto rinse theducts [6]. Despite the complexity of approaches, including duct pressure regulation and antimicrobial measures, there are risks of liver abscesses, liver failure and sepsis. This necessitates the development ofnew surgical strategies for thetreatment of thispathology. 132 Volume 4, issue 8, 2025 The purpose of the study. Optimization of approaches to surgical intervention in choledocholithiasiswith complications intheform ofpurulent cholangitis. Materials and methods of the study. The study included data on 70 patients suffering from choledocholithiasis and hospitalized in the ASMI clinic for the period from 2023 to 2024. Most patients (78%) were of working age, which emphasizes the special importance of postoperative rehabilitation and prevention offunctional disorders in thesocio-economiccontext. Study results. Conservative treatment of choledocholithiasis can lead to delays in operations, which occurs against the background of a serious condition of patients, deterioration of the gallbladder and unfavorable conditions in the intervention area. The main indication for surgical intervention in choledocholithiasis isthepresence ofdestructive changes in thegallbladder. The best results are achieved when emergency operations are performed in the first 1-3 days after hospitalization or delayed operations after 4-7 days. The time of the operation and its priority are determined by the degree of destruction of the gall bladder. Prophylactic cholecystostomy in acute isolated cholecystitis is justified only in patients in critical condition, which was rare in our observations - only 1% of cases. From Table 1 it is clear that the largest number of surgical procedures was open cholecystectomy, and also choledocholithotomy with intraoperative cholangiography, external drainage of the common bile duct and drainage of the subhepatic space (a total of 21 operations). This type of operation was also performed in case of extensive peritonitis (2 operations), it was supplemented by sanitation of the abdominal cavity through lavage and drainage. Nevertheless, the median approach was used, and in order to reduc