The dissertation highlights the constructive issues of the laparoscopic method in acute calculous cholecystitis against the background of COVID-19-associated infection and suggests ways to prevent the development of predictable complications in the perioperative period. The study analyzed the comparative dynamics of blood biochemical parameters when using carboxyperitoneum and laparolifting to create a working space in patients with respiratory manifestations of COVID-19 infection. The developed personalized approach to choosing a treatment method for patients with surgical pathology involves the following prediction algorithm:
– making a diagnosis based on clinical, laboratory, and instrumental examination methods;
– development of indications for surgical treatment;
– assessment of the severity of the patient's condition according to SAPS II;
– selection of the method of surgical intervention (use of carboxyperitoneum or laparolifting);
– measures to reduce the incidence of postoperative complications and mortality.
It has been proven that patients with COVID-19 infection have a pronounced tendency to thrombosis and coagulopathy, which should be taken into account when preparing for emergency surgery. These include mesenteric arterial thrombosis, lower extremity arterial thrombosis, perianal venous thrombosis, and thrombophlebitis. It has been shown that during the pandemic, the number of patients with severe anesthetic risk was significantly higher. During the pandemic, patients had a significant decrease in blood oxygen saturation, and an increase in fibrinogen and prothrombin index before surgery, indicating an increased tendency to thrombosis and coagulopathy. Patients with COVID-19 respiratory infection had elevated creatinine before surgery, indicating renal function stress due to direct viral cytopathic effects on the renal epithelium. It has been proven that as a result of endovideoscopic holecystectomy with the developed laparolifting device in patients with COVID-19 respiratory infection, the period of inpatient treatment was significantly shorter, and complications were much less common. It has been shown that in patients with COVID-19 respiratory infection, hemodynamic stress was significantly lower during cholecystectomy using the developed laparolifting device compared to that in patients with gas insufflation. The elaboration of approaches to the prevention of respiratory system disorders in patients with COVID-19 respiratory infection after laparoscopic cholecystectomy using laparolifting technology was further developed, as well as the creation of a working manipulative space during its implementation. It has been proven that in patients with COVID-19 infection, cholecystectomy using the developed laparolifting device during the operation, the decrease in SpO2 saturation was significantly lower than in patients undergoing laparoscopic cholecystectomy using pneumoperitoneum, and the peak airway pressure during laparolifting was significantly lower. It has been proven that in the surgical practice of cholecystectomies in patients with COVID-19, the use of a mechanical abdominal dilator (laparolift) has shown a significant advantage over carboxyperitoneum, reduced perioperative pulmonary complications, prevented the development of hypoxemia, and expanded the indications for laparoscopic cholecystectomies in patients with respiratory disorders. The leading scientific provisions of the dissertation are adapted for implementation and application in real conditions of a wide network of institutions of practical health care.
Key words: calculous cholecystitis, COVID-19 infection, laparolifting, laparoscopic cholecystectomy, oxygen therapy, thrombosis, coagulopathy, intestinal obstruction, abdominal trauma, programmed laparoscopy, minimally invasive surgical interventions, antibiotic therapy, preoperative period, postoperative period, cholelithiasis.
