Moroz V. Optimization of surgical treatment in patients with acute cholecystitis high operational and anesthetic risk

The thesis theoretically substantiated and presented a new approach to solving a scientific task to improve the results of surgical treatment of patients with severe (Grade II, Grade III) acute cholecystitis (AC), which have high operational and anesthetic risk (OAR) through a differentiated approach to the definition of the surgical tactics, choice of type, method, and timing of surgery. The basis of the study is the analysis of results of examination and complex treatment of 222 patients with AC with indicated clinical course and high OAR (ASA?III). Systematization of materials was held according to the guideline TG13. Results of surgical treatment of patients in the control group indicate the lack of effectiveness of the traditional surgical treatment. Optimized tactic involves two-step surgical treatment in patients with AC - antegrade ultrasound guided puncture-draining endo-biliary interventions as the first stage of treatment and surgery cholecystectomy or laparoscopic cholecystectomy as a second step. The effectiveness of optimized tactics was confirmed clinically and in research dynamic of the spectrum of fatty acids (FA) in serum and bile and serum cytokines. Based on the analysis of serum and bile fatty acid spectrum parameters prognostic criteria of risk of postoperative inflammatory complications was developed and the optimal timing of cholecystectomy surgery - the second stage of treatment was determined. Using optimized surgical tactics allowed in the intervention group compared with the control to achieve a statistically significant reduction in the incidence of urgent cholecystectomy from 71.7% to 26.1% (p<0,01), increased frequency of miniinvasive antegrade ultrasound guided puncture-draining surgical interventions - from 13.3 % to 86.3% (p<0.01), increased frequency of planned cholecystectomy from 15.8% to 70.4% (p<0.01), reduction of the conversion rate from 11.5% to 4.8% (p=0.14); reduction in the incidence of relaparotomy from 10.5% to 2.5% (p=0.02), the frequency of postoperative complications from 21.9 to 11.1% (p=0.04), including inflammatory - from 19% to 8,6% (p=0.04), mortality rate of 8,3% to 3,9% (p=0.17).