[Antegrade papillosphincterotomy in laparoscopic cholecystectomy]

Stenotic lesions of the distal part of the common bile duct are often revealed in laparoscopic cholecystectomy. From 1997 intraoperative antegrade papillosphincterotomy (APST) has been introduced in clinical practice of the endoscopic department of the A.V. Vishnevsky Institute of Surgery as the method able both to treat choledocholithiasis and restore adequate bile outflow. Indications to APST were stenosis of Vater's papilla (13 patients), stricture of a terminal part of the common bile duct (6 patients), choledocholithiasis in combination with distal bile duct stenosis (20 patients), isolated choledocholithiasis (4 patients). APST was successful in 36 patients and in 35 ones it was a final procedure for correction of ducts lesions. There were no complications of APST. It is an effective method in the treatment of intraoperatively defected stenotic lesions of the biliary tracts and choledocholithiasis. It makes the base of one-stage surgical policy in line with cholangioscope-assisted lithoextraction, intraoperative retrograde papillosphincterotomy and balloon dilatation of Vater's papilla. Antegrade papilloshincterotomy in patients with cholelithiasis and lesions of the ducts revealed during surgery permits one to reduce number of complications, time of hospital stay and increase comfort of surgical care.