Острый холецистит: возможности лапароскопической хирургии

Aim : to improve the results of surgical treatment of patients with acute cholecystitis due to the widespread introduction of early laparoscopic operations, reduction of indications for conservative treatment and decompression puncture methods. Material and methods . This paper summarizes the experience of treating 3140 patients with acute cholecystitis, who underwent laparoscopic cholecystectomy. The author adheres to active surgical tactics — laparoscopic surgery in the first 2—15 hours from admission in the absence of absolute contraindications to the pneumoperitoneum. Results . The technical features of laparoscopic operations for various forms of acute cholecystitis are considered. The reasons for the unsatisfactory results of surgical treatment of the disease are discussed — late hospitalization and the use of ineffective conservative therapy. The negative consequences of multi-stage acute cholecystitis treatment methods are reflected. The algorithm of early radical surgical intervention was determined. The nature of inflammatory changes in the gallbladder wall and nearby space tissues, as well as the adhesions in the abdominal cavity, did not influence the decision on the timing of the operation and the choice of method. Conclusion . Thus, radical surgery in the laparoscopic version in the vast majority of patients with destructive cholecystitis, in the shortest possible time from the onset of the attack or admission to the hospital, should be considered as a “surgery of choice”, accompanied by a minimum number of complications.