Specific considerations regarding comorbidity structure in patients afflicted with choledocholithiasis with concomitant mechanical jaundice

June 18, 2024
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УДК:  616-06:[616.366-003.7+616.367+616.36-008.5]
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Aim: to investigate and stratify the structure of comorbidity of patients afflicted with choledocholithiasis with concurrent mechanical jaundice, to highlight bidirectional relationships between cholelithiasis and concomitant diseases, including metabolic, cardiovascular, gastrointestinal and cardiac disorders, thus characterizing common risk factors, pathophysiological mechanisms and genetic morbidity, and evaluating the influence of accompanying nosology on treatment strategy.

Object and research methods. In the period from 2019 to 2023, we conducted a study evaluating the presence and structure of concomitant pathology afflicting patients with choledocholithiasis complicated by mechanical jaundice in the surgical department No. 2 of the Kyiv City Clinical Hospital of Emergency Care. 297 patients participated in the study. The mean age of participants was 59.2 years, males 41.07%, females — 59.93%.

The results. The results of the revealed comorbidity were stratified by condition severity and three age groups — 18 to 39, 40 to 59, and >60 years. The influence of comorbidities on the surgical treatment of choledocholithiasis complicated by mechanical jaundice was characterized in accordance with the 2018 Tokyo Clinical Guidelines for the Treatment of Acute Cholangitis and Acute Cholecystitis taking into account the Charlson Comorbidity Index and the American Society of Anesthesiologists physical status classification system. The role of these indicators in preoperative risk assessment, surgical decision-making and prediction of postoperative results were outlined.

References

  • 1. Li S., Guizzetti L., Ma C. et al. (2023) Epidemiology and outcomes of choledocholithiasis and cholangitis in the United States: trends and urban-rural variations. BMC Gastroenterol., 23(1): 254. doi: 10.1186/s12876-023-02868-3.
  • 2. Shaffer E.A. (2006) Gallstone disease: Epidemiology of gallbladder stone disease. Best Pract. Res. Clin. Gastroenterol., 20(6): 981–996. doi: 10.1016/j.bpg.2006.05.004.
  • 3. Tazuma S. (2006) Gallstone disease: Epidemiology, pathogenesis, and classification of biliary stones (common bile duct and intrahepatic). Best Pract. Res. Clin. Gastroenterol., 20(6): 1075–1083. doi: 10.1016/j.bpg.2006.05.009.
  • 4. Frybova B., Drabek J., Lochmannova J. et al. (2018) Cholelithiasis and choledocholithiasis in children; risk factors for development. PLoS One, 13(5): e0196475.
  • 5. McNicoll C.F., Pastorino A., Farooq U. et al. (2023) Choledocholithiasis. Treasure Island (FL): StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK441961/.
  • 6. Karamanos E., Inaba K., Berg R.J. et al. (2017) The Relationship between Age, Common Bile Duct Diameter and Diagnostic Probability in Suspected Choledocholithiasis. Dig. Surg., 34(5): 421–428. doi: 10.1159/000455272.
  • 7. Charlson M.E., Pompei P., Ales K.L., MacKenzie C.R. (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J. Chronic Dis., 40(5): 373–383. doi: 10.1016/0021-9681(87)90171-8.
  • 8. Doyle D.J., Hendrix J.M., Garmon E.H. (2024) American Society of Anesthesiologists Classification. In: StatPearls. Treasure Island (FL): StatPearls Publishing.
  • 9. Okamoto K., Suzuki K., Takada T. et al. (2018) Tokyo Guidelines 2018: flowchart for the management of acute cholecystitis. J. Hepatobiliary Pancreat. Sci., 25(1): 55–72.
  • 10. Kenny R., Richardson J., McGlone E.R. et al. (2014) Laparoscopic common bile duct exploration versus pre or post-operative ERCP for common bile duct stones in patients undergoing cholecystectomy: is there any difference? Int. J. Surg., 12(9): 989–993.
  • 11. Williams E., Beckingham I., El Sayed G. et al. (2017) Updated guideline on the management of common bile duct stones (CBDS). Gut, 66(5): 765–782. doi: 10.1136/gutjnl-2016-312317.
  • 12. Cianci P., Restini E. (2021) Management of cholelithiasis with choledocholithiasis: Endoscopic and surgical approaches. World J. Gastroenterol., 27(28): 4536–4554.
  • 13. Tazuma S., Unno M., Igarashi Y. et al. (2016) Evidence-based clinical practice guidelines for cholelithiasis 2016. J. Gastroenterol., 52(3): 276–300.