Comparative analysis of the results of laparoscopic and traditional cholecystectomy in the patients with acute cholecystitis
Bakhtier Nadjiyullaevich Shamirzaev1
+ Affiliation
Summary
The aim: A comparative analysis and ways to improve the results of surgical treatment of patients with acute cholecystitis who have undergone laparoscopic or traditional methods.
Methods and Results: This report presents an analysis of the results of the treatment of 204 patients admitted to the Military Clinical Hospital of the Ministry of Defence of the Republic of Uzbekistan with acute caculous cholecystitis. Of them, 109 patients underwent laparoscopic cholecystectomy (LCE - group I) and 95 traditional cholecystectomy (TCE - group II). The age of the patients fluctuated from 16 to 79 years, females made up 161 of patients (78.9%), males 43 (21.1%). Catarrhal cholecystitis was diagnosed in 72 (35.3%) patients, acute phlegmonous in 84 (41.2%) and acute gangrenous in 48 (23.5%) patients. We consider that the attempt to perform LCE may be carried out on all patients with acute cholecystitis. If at the moment of admission to the hospital echo-signs of gallbladder wall destruction were not found, conservative therapy, as a rule, gave positive effects even after 12-24 hours, resulting in a reduction in the inflammatory process - the surgery was carried out after delayed period. During the appearance of destructive changes in the gallbladder wall, urgent surgical intervention was performed. The use of low-power laser irradiation (LGLR) on the area of the gallbladder in the process of the patient's preoperative preparation resulted in a significant decrease in inflammatory changes in its wall and in the surrounding tissues. During the operation, infiltrates and scar tissues become loose, easily separated, and the effect of "sliding" occurs allowing fast identification of the organs and tubular structures in the zone of operation. The total lethality was 2 (1.4%) of 95 patients after TCE. There were no lethal outcomes in the group of patients who had undergone the laparoscopic method of treatment.
Conclusion: 1.The performance of early laparoscopic operation in destructive forms of acute cholecystitis allows the avoidance of intraoperative complications during separation of the rough scar-infiltrative conglomerates in the hepato-pancreatic-duodenal zone, and shortening of the duration of the operation. 2. In patients with rough scar changes in the area of the gallbladder posterior wall, all the posterior wall or such parts of it that cannot be isolated from the liver bed remain in place with consequent performance of plasma laser or electric coagulation of the mucous membrane. 3. The use of low-power laser irradiation in the preoperative period considerably facilitates the technique of LCE in patients with acute cholecystitis, and reduced intra- and postoperative complications. 4. The course of laser therapy in different forms of acute cholecystitis results in a decrease in morphological changes in the organs of the hepato-pancreatic-duodenal zone.
Keywords
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