The dissertation is devoted to the improvement of results of the surgical treatment of acute calculouscholecystitis in patients with chronic viral hepatitis by scientifically substantiated expediency of using early express diagnosis of concomitant chronic viral affections of the liver at the preoperative stage with subsequent targeted appropriate preoperative preparation, therapy in the early postoperative period and optimization of the technique of one of the most important stages of the laparoscopic cholecystectomy (LChE) using clips, which meet modern requirements. The results of diagnosis and treatment of 1832 patients with acute calculous cholecystitis (ACC) were analyzed in the dissertation for the period from 2012 till 2017. In the first stage, from 2012 to 2014, only a thorough survey was conducted during the preoperative period in order to identify potential risk factors for infection and anamnestic data on the presence of chronic viral hepatitis, diagnosed in the past. In the second stage, from 2015 to 2017, early diagnostic algorithms for the preoperative period, along with the survey, early express tests for antigens and anti-CVH antibodies were introduced. At the first and second stages of hospitalization all patients were studied clinical data, laboratory indices: blood count, biochemical (alanine aminotransferase, aspartate aminotransferase, total bilirubin and fractions, total protein), blood clotting time, prothrombin index and international normalized ratio; instrumental examinations were performed (ultrasound diagnostics, esophagogastroduodenoscopy, computed tomography, electrocardiography). In the second stage, to diagnose the severity of the inflammatory process activity and the immune response, determination of the severity of the endogenous intoxication syndrome was made by calculations of a number of integral leukocyte indices in 27 patients with ACC and CVH. At the third final stage of the study, the results of surgical treatment of patients with AChC (n = 1832), including those with CVH (n = 82), were analyzed, in whom during LCE, metal and polymer clips were used for clipping the elements of the gallbladder neck. At this stage, the proposed treatment algorithm was performed in patients with ACC with CVH. Depending on the chosen therapeutic regimen in the pre- and postoperative period, patients were divided into two groups: the comparison group (n = 13) who received baseline preoperative preparation, while patients (n = 14) of the experimental group received the same treatment as patients of the comparison group and additionally arginine glutamate. Thus, 23 (2.3 %) patients were diagnosed with hepatitis infection by the survey from 2012 to 2014 and they formed a control group. Thus, 59 (7.2 %) patients of the main group were diagnosed with chronic liver affection by means of surveys and early express diagnosis during period from 2015 to 2017. One of the most important tasks during surgical intervention is the application of the most minimally traumatic techniques, especially in the presence of CVH. All the above suggests significant advantages when using the polymer clips.
