Kolomiytsev V. Minimally invasive surgery in complicated acute calculous cholecystitis.

The thesis is devoted to the improvement of efficacy of the treatment of patients with acute cholecystitis (ACh) complicated by the obstructive jaundice, cholangitis and biliary pancreatitis by means of differentiated surgical management using minimally invasive techniques.The investigation of indications and contraindications, special features, efficacy, stages and terms of the minimally invasive interventions was performed depending on the type and severity of complications. The diagnostic program, methods and technical approaches to therapeutic ERCP and laparoscopic operations in patients with complicated ACh were innovated. Mathematical forecasting of the bile duct injury during the laparoscopic cholecystectomy, estimation of the probability of conversion to open surgery and laparoscopic bile duct clearance in patients with complicated ACh, and analysis of the prophylaxis of postoperative complications were performed. Active diagnostic and surgical tactics as well as implementation of the single- and two-stages procedures were shown to lead to increase of the number of minimally invasive surgeries, avoidance of conversions and bile duct injuries, decrease of the number of postoperative complications and mortality in patients with complicated ACh, and improvement of their quality of life in the future