CONSIDERATION OF MORPHOLOGICAL-FUNCTIONAL CHANGES IN THE COMPONENTS OF CALOT’S TRIANGLE IN ACUTE CHOLECYSTITIS AND THEIR INFLUENCE ON THE SPECIFIC LAPAROSCOPIC CHOLECYSTECTOMY TECHNIQUE IN PATIENTS WITH ACUTE CHOLECYSTITIS

Abstract

From 2018 to 2023, a study was conducted on 89 (100%) patients operated on for acute cholecystitis in the surgical department of the Storozhynets Multidisciplinary Hospital for Intensive Care.The goal is to study the clinical features of acute cholecystitis based on the results of surgical treatment in the general surgery department of a multidisciplinary district hospital for intensive care.Materials and methods. From 2018 to 2023, 89 patients who underwent surgery for acute cholecystitis were studied in the surgical department of the Storozhynets Multidisciplinary Hospital for Intensive Care. Clinical, laboratory, instrumental examinations, and surgical treatment were performed on 89 patients of various age groups (from 18 to 74 years) with manifestations of acute cholecystitis. The patients were divided into two groups. The diagnosis was confirmed clinically, laboratory, by instrumental methods, intraoperative examination, and histological study of the removed specimens. The state of changes in peripheral blood was assessed: the number of erythrocytes, hemoglobin content, number of leukocytes, leukocyte formula, erythrocyte sedimentation rate, and leukocyte intoxication index according to the Kalf-Kalif formula. Statistical processing of the material was performed using the t-test with the determination of the probability corresponding to the Student's t-criterion. When performing statistical processing, the arithmetic mean (M) and the reliability of differences in study results (p) relative to the indicators of different groups were calculated. The results were considered reliable when the confidence coefficient was less than or equal to 0.05.Results. The results of our laparoscopic cholecystectomies for grade I and II (moderate) severity of acute cholecystitis (according to the International Classification) showed a quantitative advantage in prioritizing the laparoscopic method of surgical intervention. However, in the presence of a purulent-inflammatory process in the hepatobiliary zone, priority is given to performing cholecystectomy by the "open method," involving highly experienced surgeons in the surgical team. This option of cholecystectomy is advisable mainly for severe acute cholecystitis (stage III of the pathological process) with a purulent-necrotic process in the hepatobiliary zone detected at the preoperative stage and in the case of peritonitis. Contraindications for laparoscopic cholecystectomy include chronic duodenal obstruction, gangrenous-perforative cholecystitis, and diffuse peritonitis. Considering the features of surgical tactics for treating acute cholecystitis confirms the need for its differentiated determination based on already developed tactical and therapeutic recommendations, the effectiveness of which is evidenced by the accumulated experience of the international school of surgeons and confirmed by our clinical results.Conclusions. 1. Laparoscopic cholecystectomy is currently performed for both chronic and acute cholecystitis. 2. The most optimal time for performing "laparoscopic cholecystectomy" is the first two days from the onset of the inflammatory process in the gallbladder. 3. Performing laparoscopic cholecystectomy considering anatomical landmarks according to the recommendations for "safe cholecystectomy" by Steven Strasberg (1992, 1995 - SVS) and Gary G. Wind (1999) is an effective component of successful laparoscopic cholecystectomy for chronic cholecystitis and in the early stages of acute inflammatory processes in the gallbladder. 4. For acute destructive cholecystitis, the "elephant trunk" technique is practically preferred.