Minilaparotomy choledocholithotomy in patients with metabolic syndrome

Aim. To evaluate the outcomes of mini-laparotomy choledocholithotomy in patients with choledocholithiasis and metabolic syndrome using “Mini-Assistant” instruments.

Materials and Methods. This study is based on the outcomes of surgical interventions performed on 54 patients diagnosed with choledocholithiasis accompanied by metabolic syndrome, conducted between 2009 and 2022. A minimally invasive laparoscopic approach was utilized, employing “Mini-Assistant” instruments. Preoperative assessments included laboratory tests, ultrasound examination, electrocardiography, echocardiography, respiratory function testing, chest radiography, esophagogastroduodenoscopy, and magnetic resonance cholangiopancreatography (MRCP). The miniaccess operation was performed using a transrectal incision, 6-7 cm in length. The technical steps of the operation were similar to traditional cholecystectomy and choledocholithotomy.

Results. The average duration of the procedure was 68 ± 9.3 minutes. The patients’ condition before and after surgery was satisfactory, with stable hemodynamics. No hypertensive crises or tachycardia were observed. No mortality was reported. Postoperative complications were observed in three patients, including accumulation of serous fluid in the subcutaneous tissue (2 cases) and postoperative pancreatitis (1 case). The average length of hospital stay after choledocholithotomy via mini-access was 6 ± 1.6 days.

Conclusion. Mini-laparotomy choledocholithotomy using the “Mini-Assistant” instrument set allows for avoiding conventional, more invasive techniques, facilitating effective surgical intervention even in cases where laparoscopic procedures are not feasible.

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