Kravchenko S. The reasons of conversion and choice of access for its end at performance of laparoscopic cholecystectomy

The dissertation is devoted to urgent questions of surgical tactics and treatment at the patients with acute and chronic calculus cholecystitis. In a basis of work carried out the results of laparoscopic cholecystectomy at 1503 patients with acute and chronic calculus cholecystitis (basic group), from which at 49 patients the conversion was observed, and the operation was completed with use open laparotomy. All patients are distributed on 2 groups. First group was made with 1320 patients with chronic calculus cholecystitis , with which laparoscopic cholecystectomy was carried out in the scheduled order with conversion in 25 (1,9 %) cases. Second group was made with 183 patients with acute cholecystitis, with which laparoscopic cholecystectomy was carried out urgently with conversion in 24 (13,1 %) cases. The concept of active - individual tactics at the patients with acute cholecystitis is developed on the basis of the account of time from the moment of disease before operation, and also criterion ofprognostic conversion allowing beforehand to provide an opportunity of transition to open laparotomy, which kind (minimal, traditional) is determined by character of the arisen critical situation at performance of laparoscopic cholecystectomy. In case of conversion at performance of laparoscopic cholecystectomy is developed the different approach to a choice of variant of open access as the regulated indications to minimal and traditional laparotomy on a basis not oppositions, and as the performance of a necessary stage in the circumstances, that allows effectively and with minimal trauma to finish operation.