METHOD FOR ENDOSCOPIC SPHINCTER-PRESERVING ATYPICAL PAPILLOTOMY IN CHOLEDOCHOLITHIASIS Russian patent published in 2022 - IPC A61B17/94 A61B17/00 A61B17/32 A61B17/221 A61B18/14 

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely abdominal surgery, operative intraluminal endoscopy. A partial papillotomy is performed with a length of 6 mm from the mouth of the major duodenal papilla (MDP). Stents are temporarily placed in the main pancreatic duct and bile duct with its subsequent removal. During atypical papillotomy, an incision of the mucous and submucosal layers is performed up to the first transverse fold. A saline solution is injected with diluting 0.4% indigo carmine solution into the submucosal layer of the edges of the papillotomy incision. A transverse incision of the mucosa with a length of 5 mm is performed on both sides of the stent in the area of the lower edges of the papillotomy incision, preparation in the submucosal layer of the edges of the papillotomy incision to the muscle fibers of the MDP sphincter from the base of the incision at the border with the stent to the upper edge of the incision with dilution of the edges. From 3 to 5 incisions of muscle fibers are performed with a length of 1 mm along the upper semicircle of the preserved portion of the MDP muscle sphincter above the stent.

EFFECT: method makes it possible to increase the effectiveness of endoscopic treatment of choledocholithiasis due to precision dissection of the mucous and submucosal layers of the MDP ampoule, including fibrously altered areas, and preservation of unchanged muscle fibers of the Oddi’s sphincter and its functional consistency, to increase the possibility of extraction of large-sized concretions by minimizing the negative effect of the mucous and submucosal layers on the extensibility of the preserved Oddi’s sphincter, prevents the development of stenosis in the long term after surgery by increasing diastasis between the edges of the papillotomy incision, as a result of which there is no formation of a linear scar above the stent, reduces the number of operational stages.

1 cl, 3 dwg, 2 ex