Syvolap D. Development of indications and improvement of methods of organ-preserving operations in patients with cholecystolithiasis.

The dissertation is dedicated to the improvement of the results of surgical treatment of patients with cholecystolithiasis by means of combined organ-preserving intervention: laparoscopic cholecystolithotomy with intraoperative endoscopic papillosphincterotomy. The scientific novelty of the study lays in the fact that the new scientific evidence was obtained regarding the benefits of the organ-preserving LCLT surgery in patients with asymptomatic cholecystolithiasis with a pathogenetic determination of relevance of the performance of one-stage intraoperative EPST. For the first time it was determined that in case of the prolonged clinical course of asymptomatic cholecystolithiasis, organic changes in the zone of a major duodenal papilla of stenotic character arise and progress with the increase of the connective tissue component, which is a morphological substrate of the difficult passage of bile through its ampulla to the duodenum. It was proven for the first time that every second patient with cholecystolithiasis does not have ursodeoxycholic acid in the gallbladder bile. Evidence-based database and scientifically grounded possibilities of introduction of organ-preserving interventions on the gall bladder in patients with asymptomatic cholecystolithiasis with saved motor-evacuation function are created. The factors influencing the possibility of asymptomatic transient hyperamylasemia and prolonged hyperthermia in the postoperative period after laparoscopic cholecystolithotomy and cholecystectomy are determined.