A 42-year-old man was delivered to a surgical in-patient department with complaints of icteric skin, pain in the right subcostal area. Biochemical blood analysis: total bilirubin - 140 mcmol/l, direct bilirubin - 112 mcmol/l. On US: choledochal duct - 1,4 cm, a concrement is detected in the distal area. Gallbladder is 40 cm, no concrements. What treatment tactics should be chosen?

Answer options

1. Endoscopic papillosphincterotomy
2. Laparotomy with cholecystectomy
3. Laparotomy with choledoch duct drain
4. Laparoscopic cholecystectomy
5. Threatment in an infectious diseases hospital

Explanation

The patient has choledocholithiasis. ERCP and endoscopic sphincterotomy are the treatment of choice at most centers' Successful clearance of BD in more than 90 % of patient's Definitive treatment of BD stones in post cholecystectomy patients The most common treatment of BD stones when laparoscopic cholecystectomy is planned and BD stones are documented or strongly suspected Permits leaving gallbladder intact after ERCP in patients at elevated risk for surgery; the need for subsequent cholecystectomy is 10 to 20 % within 5 to 10 years. Jacobson Ira M. Weine Handbook of Liver Disease / Ira M. Jacobson, Douglas M. Weine. –Third Edition. – 2012.