Abstract
The aim of the research was to study the feasibility and effectiveness of simultaneous laparoscopic hernioplasty and cholecystectomy in patients with combined abdominal pathology. Material and methods. Simultaneous laparoscopic hernioplasty and cholecystectomy during 2015–2019 performed on 70 patients, including 49 (70 %) women, mean age 57.3 ± 6.5 g. In 37 patients the principles of Fast-track surgery were applied (group I), including thorough examination for diagnostics of combined abdominal pathology and clinically significant general somatic pathology; if necessary a course of therapy for full compensation of general somatic pathology was prescribed; during the operation of epidural prolonged anesthesia; choice in favor of laparoscopic technology; at the end of the operation – irrigation of the subdiaphragmatic space with local anesthetic; postoperatively: early drainage removal; withdrawal from opioids by prescribing parenteral paracetomol; activation of the patient 6-8 hours after surgery; on the day of surgery – use of chewing gum and fluid intake. In 33 patients the standard complex of perioperative management (group II) is applied. The immediate results of surgical interventions have been studied. Results. There were no significant complications during the operation and in the early postoperative period. In the first group, seroma (after open alloplasty) was detected in 2 (5 %) cases, and in the second group, small wound complications were detected in 4 (12 %) cases (p > 0.05 according to the χ2 criterion). The duration of inpatient treatment in patients of group I is 4.4 ± 1.2 months, in group II – 7.0 ± 1.3 days (р < 0.001 by Student’s test). Conclusion. Application of the principles of Fast-track surgery and accelerated recovery at all stages of simultaneous laparoscopic hernioplasty and cholecystectomy (preparation for surgery, during the operation and in the postoperative period) does not increase the number of postoperative complications and decreased duration of inpatient treatment from 7,0 ± 1,3 in patients with traditional postoperative management to 4,4 ± 1,2 days.
Highlights
The introduction of videoendoscopic technologies into routine practice of abdominal surgery has significantly expanded the possibilities of the operative treatment of various pathologies [1]
Many researchers report good results of simultaneous surgeries [2, 3, 4], but so far their frequency does not correspond to the prevalence of concomitant pathology [5]
The main argument against simultaneous interventions is the increase in the volume of the surgery, correspondingly increasing the degree of surgical aggression and the risk of adverse events in the postoperative period
Summary
The introduction of videoendoscopic technologies into routine practice of abdominal surgery has significantly expanded the possibilities of the operative treatment of various pathologies [1]. The main argument against simultaneous interventions is the increase in the volume of the surgery, correspondingly increasing the degree of surgical aggression and the risk of adverse events in the postoperative period. This is especially true for elderly and senile patients with concomitant general somatic pathology, in which there is already a high risk of postoperative complications [5]. This particular contingent is characterized by high comorbidity with the presence of several diseases requiring surgical treatment [6, 7]
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