Optimization of diagnosis and treatment of acute cholecystitis and modern measures for prevention of intraoperative and postoperative complications

Pavlovych Yu.V.,Kryzhevsky V.V.,Bilyayeva О.О.

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Optimization of diagnosis and treatment of acute cholecystitis and modern measures for prevention of intraoperative and postoperative complications

April 13, 2022

644

Keywords :

laparoscopic cholecystectomy,

wound protector

Specialities :

Surgery

Resume

Objective: to improve the results of surgical treatment of patients with acute cholecystitis.

Object and methods of research. A retrospective analysis of patients who underwent laparoscopic cholecystectomy (LHE) in the surgical departments of the Kyiv City Hospital № 6 and MC «Universal Clinic Oberig» from 2015 to 2020 was performed. The main group included patients who underwent in 2015–2017 intraoperatively the method of «critical view of safety» (CVS) to prevent complications of LHE. The comparative group included patients who performed LHE in 2018–2020, which used classical methods («elephant trunk», the creation of «two windows»).

Results. The frequency of complications in the comparison group was 28.2%, in the main group — 20.9%. The conversion rate in the comparison group is 6.1%, in the main group — 4.2%. Such indicators are the result of applying the CVS method. The use of a two-ring wound protector during surgery reduced the frequency of suppuration of postoperative wounds from 7.0 to 2.9%.

Conclusions. The results of treatment of patients with acute cholecystitis depend on the timing of treatment and timely treatment of patients. C-reactive protein is an objective criterion for the course of the inflammatory process. ASA scale and the distribution of patients according to the Tokyo guidelines are important tools for the proper selection of patients for LHE. CVS is the only safe method that prevents intraoperative complications and the occurrence of conversion. The conversion is not a defeat for the surgeon, but evidence of his prudent approach to the safe performance of LHE.

References

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