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CNAA / Theses / 2005 / June /

Diagnosticul şi tratamentul megacoledocului secundar


Author: Adrian Hotineanu
Degree:doctor of medicine
Speciality: 14.00.27 - Surgery
Year:2005
Scientific adviser: Gheorghe Ghidirim
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Institution:
Scientific council:

Status

The thesis was presented on the 24 June, 2005
Approved by NCAA on the 22 September, 2005

Abstract

Adobe PDF document1.50 Mb / in romanian

Thesis

CZU 616.316-089+616.368-089

Adobe PDF document 5.51 Mb / in romanian
98 pages


Keywords

megacoledochus, ERCP, coledoch exeresis, coledochojejunostomie, cronic cholangitis

Summary

In a group of patients from 5% to 10%, although the biliary flow was reestablished after ERS, the biliary pathology persists manifested through the clinical picture of transitory mechanical jaundice, chronic cholangitis and primary choledocholytiasis. Reinstallation of the biliary pathology is caused by the development of duodenobiliary reflux, on the background of duodenostasis and insufficiency of papilla Vater.

This research was carried out for a period of 12 years (1992-2004), including a number of 47 patients, who have been treated at the Nr.2 Surgery Department, Gastrosurgey Unit. All the patients underwent colecistectomy and afterwards reinterventions on biliary tract including ERS, CDA with choledocholytotomy.

The diagnostical algorithm included: biochemical tests, US, ERCP, duodenography, biliscintigraphy, manommetry, MRI and morfological invetigation of the choledoch. The paraclinical investigations demonstrated the presence of duodenostasis and duodenal malrotation, duodenobiliary reflux, CBD over 2 cm with primary stones with a good permiabiliy of the papila of Oddi and with organic changes occurring on the choledochal wall, these including muscular dystrophy, degeneration of nervous fibers and installation of choledochal diffused fibrosis. The dilated CBD functionally atonic was named by us secondary megacholedoch.

Until 1998 the surgical treatment in 15 patients included biliodigestiv anastamosis (CDA and choledochojejunoanastamosis). The results were unsatisfactory because more than in 50% the clinical signs persisted, caused by the mentainance of the duodenobiliary reflux. This considerations allowed us to propose and implement a new operational technique which excludes the duodenobiliary reflux, consisting in supraduodenal excision of CBD with its implantation in Y loop à la Roux. This tactic of treatment allowed the recovery of the patients with socioprofessional reintegration in 96,77%.