Kvasnievskiy O. Prevention and operative treatment of complications during the gallbladder minimally invasive surgery

The thesis is devoted to the problems of predicting the occurrence of complications during the gallbladder minimally invasive surgery, their prevention and surgical treatment. The study was organized in two stages. The first stage included a retrospective analysis of perioperative complications after the gallbladder minimally invasive operations in 911 patients (a comparison group) at the time period 2013–2015. At the same time, independent risk factors for complications were identified, their pathogenetic role and specific influence of each factor were assessed, and clinical and epidemiological subgroups of the complications probability occurrence were formed. At the second prospective stage (years 2016–2018) in 845 patients (the main group) the analysis of the effectiveness of the applied program of prevention of perioperative complications depending on the distribution of patients into clinical and epidemiological subgroups was performed. According to the results of the study we developed the scheme of prevention of complications in patients with gallbladder diseases, which was based on their distribution by clinical and epidemiological subgroups of complications occurrence after LCE, gave a reliable clinical result in reducing complications from 10 to 5.8% (2=10.5; p=0.002). And the most severe of them, associated with damage to the extrahepatic bile ducts, were not observed. Lethality rate in the experimental groups was 11 (26.2%) cases in the comparison group and 4 (9.8%) in the main group (p<0.049; Fisher’s exact test).