Evaluation of the effectiveness, causes of failures and complications of complex minimally invasive treatment of «complex» choledocholithiasis

Objective. The aim of the study was to improve treatment outcomes for patients with “complex” choledocholithiasis through the combined use of modern minimally invasive methods and to develop an algorithm for their clinical application. Material and methods. A retrospective analysis of minimally invasive treatment in 245 patients with “complex” choledocholithiasis was performed. The study group consisted of 187 patients: 150 underwent endoscopic papillary large balloon dilation (EPLBD) following limited endoscopic sphincterotomy (EST) with subsequent stone extraction; 20 underwent intraductal lithotripsy; 17 underwent extracorporeal shock wave lithotripsy (ESWL). The control group consisted of 58 patients treated solely with standard endoscopic mechanical lithotripsy (ML). Results. The success rate of the combined approach in the study group was 91.5%. The use of new technical approaches significantly reduced postoperative complications to 3.2%. The rate of surgical interventions required due to the failure of minimally invasive methods was 8.0%, which was statistically significantly (p<0.05) lower than in the control group treated with mechanical lithotripsy alone (8.6% and 13.8%, respectively). Based on these results, a modern algorithm for the combined use of minimally invasive approaches in treating “complex” choledocholithiasis was developed. Conclusion. The proposed integrated approach, based on a sequence of EPLBD with limited EST, intraductal lithotripsy, ESWL, and ML, improves the efficacy of minimally invasive interventions, decreases postoperative complications, and reduces the need for open surgery in patients with “complex” choledocholithiasis.