Kravets K. The role and place of laparoscopic interventions in surgical treatment of destructive forms of acute cholecystitis complicated by peritonitis

The thesis is devoted to substantiation of strategy and treatment of patients with acute cholecystitis complicated by peritonitis (ACCP) and role of application of laparoscopic interventions in this category of patients of surgical hospitals on the basis of studying results of treatment of the patients according to the scales of risk due to age-related changes in the body, concomitant pathology, with the application of various surgical techniques, and the involvement of the main provisions of the “Early rehabilitation after surgery“ program. Pre - and intraoperative clinical-instrumental diagnostic algorithm and surgical treatment algorithm in patients with ACCP have been developed and implemented, which allow to choose the optimal method of surgical intervention based on the results of pre - and intraoperative diagnosis and optimize the list of indications and contraindications for each type of surgery, which enables to increase the performance of laparoscopic interventions in this type of pathology through the use of laparo-lifting cholecystectomy (LLCE) by 12.5%. In case of destructive cholecystitis complicated by local and widespread serous and purulent peritonitis with involvement of one or 2-3 anatomical areas of the abdominal cavity, laparoscopic cholecystectomy with sanitation and adequate drainage of the abdominal cavity is indicated - 37 (56.9%) of our patients from the group of LCE and drainage. In ACCP, the patients with severe cardiovascular and respiratory pathologies (ASA IV) were performed gas-free lifting laparoscopic cholecystectomy – 8 (38.1%) of our patients from the group LLCE and abdominal drainage. Open surgery is indicated in patients with destructive cholecystitis complicated by general fibrinous-purulent peritonitis. Patients with destructive cholecystitis complicated by widespread fibrinous-purulent peritonitis were indicated open surgery - 5 (11.9%) of our patients from the group of TCE and abdominal drainage. The application of the developed method of laparo-lifting cholecystectomy revealed a decrease in intra - and postoperative complications compared with the group of laparoscopic cholecystectomies by 7.6%. The use of algorithms and updated approaches minimizes intra - and postoperative complications due to the non-invasive nature of operations and the lack of use of carboxy-pereponium in the patients with ACCP – LLCE by 4.8%, compared with TCE (23.9%). Laparoscopic methods help reduce pain, especially when using LLCE (9.5%) on the first day, compared with TCE (92.5), on the second day, even in comparison with LCE by 56.6%. The use of the ERAS (FTS) protocol reduces the number of the inhospital days spent in all followed-up groups by 1 day, given the severity of this pathology.