Kravchenko B. Single-incision laparoscopic cholecystectomy in patients with chronic calculous cholecystitis: indications, technical aspects, prediction and prevention of complications

The thesis is devoted to the improvement of the surgical treatment results in patients with chronic calculous cholecystitis by developing indications and differentiated approach to performing cholecystectomy through a single-port access with identifying and systematization of predictive factors preventing development of complications. The study is based on the personal observation results of surgical treatment, clinical, instrumental, laboratory, biochemical and special methods of patients’ examination. The research includes cases of 214 (100 %) patients with chronic calculous cholecystitis. The surgical treatment was performed on 34 (15.9 %) men and 180 (84.1 %) women. Transumbilical single-incision laparoscopic cholecystectomy was performed on 102 (47.7 %) patients (main group); traditional four-port cholecystectomy was performed on 112 (52.3 %) remaining patients (control group). The study introduces the analysis of main treatment indicators for performing single-incision and four-port cholecystectomy. Both groups of patients were representative and did not have any differences in demographic indicators or associating diseases. All patients underwent the operation as scheduled under general combined anaesthesia and artificial ventilation. Before undergoing the single-incision and four-port cholecystectomy, the patients were briefed about a informed consent form and its further signing. According to the data provided by morphological study of a gallbladder removed after cholecystectomy, both groups (main and control) demonstrated typical for chronic calculous cholecystitis signs of chronic inflammation. Ultrasound imaging showed nosological signs that correlated with morphological study, i.e. the presence of calculi within the gallbladder lumen, thickening of its walls, enlarged, detached gallbladder with deformity or inflection, content heterogeneity.