[Surgical tactics in the treatment of acute cholecystitis with lesions of the bile ducts].

The authors analyse the results of treatment of 185 patients with acute cholecystitis coexisting with affection of the bile ducts. In view of the high risk of operative treatment, endoscopic papillosphincterotomy was undertaken as the first stage in 83 patients and was completed by nasobiliary drainage in 46 of them, in still another 12 patients decompression was accomplished by means of laparoscopic cholecystostomy . Surgical intervention was carried out in the second stage after the patients recovered from a grave condition and obstructive jaundice and intoxication caused by purulent cholangitis were corrected. Another 90 patients underwent surgical operation without preliminary decompression in a postponed order (67 patients) and for emergency and urgent indications (19 patients) in vital conditions due to peritoneal phenomena. The changes in the bile ducts were corrected in them in the second stage, which reduced the risk of the development of postoperative complications. The authors emphasize the importance of two-stage treatment in coexistence of lesions and of a differential approach to the treatment of this contingent of patients according to the character and severity of the inflammatory process and the severity of the patients' condition.