Goloyad Y. Substantiation of selected operative treatment of acute cholecystitis of patients with alimentary obesity

An object - a acute cholecystitis and alimentary obesity; purpose - to improve the results of treatment of patients with a acute cholecystitis on a background alimentary obesity by the improvement of methods of surgical interference taking into account the level of endotoxicosis, concomitant diseases and possible complications; methods - clinical, laboratory, instrumental, spectrometry and statistically-analytical; results - a treatment is conducted 191 patient with a acute cholecystitis and alimentary obesity; the changes of acute-phase proteins are set, organospecific enzymes, peroxidation of lipids, antioxidant defence (transferin, ceruloplasmin, carbonic anhydrase, catalase); humoral immunity condition (Ig G, Ig A, Ig M), changes in stress hormone - cortisol. In these patients with a acute cholecystitis and alimentary obesity in the more heavy course of pathological process is marked after laparotomic cholecystectomy, what the reliable worsening of indexes of clinical methods of inspection testifies to; the content of Ig G in serum protein factions was characterized with almost three times increase of immune complexes which was located in a macroporous gel, and considerable reduction in factions 23-21, indicating worsening of these patients' natural immunity defense; laparoscopic surgery (129 patients - main group) of acute cholecystitis combined with alimentary obesity, was fulfilled under constant oximetry monitoring, with the use of lenghthened trocars, conditions for intra-abdominal pressure drop till 5-7 Mmhg, Fovler's position with turn to the left side and patient's fixation, laparolifting, retractor diminishes the risk of development of complications on 25%.