Low-invasive technologies in the treatment of calculous cholecystitis

Aim of investigation. Choice of the optimal method of treatment in patients suffering from calculous cholecystitis and its complications taking into account operational risk and modern diagnostic means and low-invasive technologies. Material & methods. Results of 4380 cholecystectomies were analyzed including: from laparatomy access - 1598, by laparoscopy method - 2604, mini-access - 178.2799 (63,9%) patients were operated for chronic calculous cholecystitis and 1581 (36,1%) - for acute cholecystitis. Among patients with acute cholecystitis 601 (38%) had catarrhal form of gall-bladder inflammation, 791 (50%) - phlegmonous cholecystitis and 189 (12%) - gangrenous cholecystitis with bladder wall destruction. Results. Clinical-laboratory findings determined in different forms of gall-bladder wall inflammation can not be determining in the choice of terms and method of operation. US data were analyzed in 1152 patients with different degree of gall-bladder inflammation. At this, a high efficacy of US was proved concerning a degree of inflammatory changes in the gall-bladder wall. Taking into account high self-descriptiveness of US in the estimation of a degree of inflammation in the gall-bladder a "selective active" tactics in acute cholecystitis was developed. It is proved that cholecystectomy from laparatomy access has the greatest negative effect on the cardio-vascular and respiratory systems and laparoscopic intervention is easier transmitted by patients as lesser traumatic even comparing to mini-access cholecystectomy. At the increase of the rate of operations with use of low invasive technologies a decrease of both specific complications from 13,7% to 1,3% and non-specific complications from 5 and 4% to 0,8% was observed. Total postoperative lethality has made 1,6%. In chronic calculous cholecystitis postoperative lethality has made 1,1%. At this, rate of nonspecific postoperative complications resulted in lethal outcome made 1% and specific - only 0,1%.