A rational approach to the prevention ofthromboembolic complications in the surgical treatment of complicated forms ofcholelithiasis in patients with liver cirrhosis

Abstract

Background. It is known from scientific sources that a significant proportion of complications of liver cirrhosis is associated with negative impact of this pathology on the coagulation system. According to many scientists, liver cirrhosis in most cases poses a risk of developing both thrombotic and hemorrhagic complications. Objective: to identify a rational approach to the prevention of thromboembolic complications in the surgical treatment of complicated forms of cholelithiasis in patients with cirrhosis. Materials and methods. We retrospectively analyzed the hospital records of 62 patients who were treated for complicated forms of cholelithiasis with verified liver cirrhosis for the period from 2005 to 2018. The distribution of patients by nosology was as follows: acute calculous cholecystitis— 48 patients, Mirizzi syndrome— 7, choledocholithiasis— 7. Results. Based on a comparative analysis of two groups, the risk of intraoperative bleeding in patients with preoperative prophylaxis was higher (3cases— 8.1 %), with a blood loss of more than 400 ml. Hematomas of postoperative wounds were observed in 5 cases in group 1 and in one case in group 2. In the group of preoperative prophylaxis, portal vein thrombosis (n = 1), thrombosis of small branches of the pulmonary artery (n = 1), and deep vein thrombosis of the leg (n = 1) developed. No such complications were observed in the group with postoperative prophylaxis. Conclusions. The decision on the prevention of thromboembolic complications in this category of patients should be balanced and include an assessment of the risks of developing both hemorrhagic disorders and complications associated with thrombosis.