Kashtalyan M. Surgical management of patients suffering from acute cholecystitis.

The thesis is devoted to the increase of efficacy of treatment of patients suffering from acute cholecystitis (ACh) by means of scientific substantiation and differentiated surgical management introduction with the usage of mini-invasive technologies. It is scientifically substantiated the expediency of ACh patients dividing into clinical-morphological groups, which stipulate the choice of therapeutic and diagnostic approach according to surgical intervention urgency. Classification of operations is done. The following methods were created and innovated: laparoscopic cholecystectomy technical aspects, method of stones falling from the gallbladder seizing out from the abdominal cavity, method of blood autoreinfusion during the laparoscopy. The staged management of ACh complicated with choledocholithiasis was elaborated. Groundlessness of traditional conception as for the favorable (before 72 hrs) and unfavorable (after 72 hrs) terms of operation is proved. There are given the evidences that laparoscopic cholecystectomy is less traumatic as compared with open cholecystectomy. The indications to the usage of "a day surgery" and a cosmetic variant of laparoscopic cholecystectomy are determined. The active differentiated therapeutic and diagnostic management improved the treatment results. The conversions frequency decreased 2 times as much, the complications and lethality rate - 1.5 times.