ПРИМЕНЕНИЕ АРГОНА ДЛЯ СОЗДАНИЯ ПНЕВМОПЕРИТОНЕУМА ПРИ ЛАПАРОСКОПИЧЕСКИХ ОПЕРАЦИЯХ

Abstract

Objective. To advance the patients’ rehabilitation after laparoscopic surgeries by using insufflation with argon gas for pneumoperitoneum formation. Methods. The given study is the investigation of sequentially admitted 360patients with gallstone disease (cholelithiasis). The patients have been randomly divided into 4 groups: Group1 - uncomplicated gallstone disease, carboxyperitoneum (n=192); Group1a - acute cholelithiasis (n=37), carboxyperitoneum; Group2 - uncomplicated gallstone disease, argonperitoneum (n=102); Group2a - acute cholelithiasis (n=29), argonoperitoneum. All the patients have undergone laparoscopic cholecystectomies. Subjective assessment of the pain syndrome intensity has been studied on the basis of patient-reported outcomes questionnaire according to the visual analogue scale (VAS), need for analgesic injections, presence and intensity of the shoulder pain syndrome as well as the duration of in-patient treatment. Results. In accordance with patient-reported outcomes (with argonperitoneum application) subjective pain sensation has proved to decrease by 1.5-2 fold. On the first day of the postoperative period both in uncomplicated gallstone disease and in acute cholelithiasis, argonperitoneum has statistically significantly reduced the need for analgesics. Pain in the shoulder girdle (omalgia) was observed in 48.9% of the patients having been applied carboxyperitoneum whereas it was noticed in only 5.3% of the patients having been applied argonperitoneum during the operation. Argonperitoneum application statistically significantly reduces in-patient treatment period by 30% (from 2.3 - to 1.6 days) in uncomplicated gallstone disease and by 23% (from 4.3 - to 3.3 days) in gallstone disease complicated by acute cholelithiasis. Conclusion. Application of argon for pneumoperitoneum formation in laparoscopic cholecystectomies reliably reduces pain syndrome intensity in the postoperative period. The number of postoperative omalgia cases is reduced by 42% in patients having undergone cholecystectomies with argonperitoneum application. Application of argonperitoneum in management of patients with cholelithiasis may reduce the hospitalization period by 25-30%. What this paper adds The effect of argon application as an insufflation gas in laparoscopic operations upon the intensity of the postoperative pain syndrome has been studied for the first time. Argonperitoneum application has been found to improve the postoperative course by reducing pain irritation. Argon application leads to reduce analgesics consumption.