EVOLUTION OF MORPHOLOGICAL CHANGES OF THE GALLBLADDER WALL AT DIFFERENT TERMS OF PERFORMANCE OF LAPAROSCOPIC CHOLECYSTECTOMY

Abstract

Gallstones are present in approximately 10-15 % of the adult population in Western countries, with 1-4 % of patients experiencing symptoms each year. Recent guidelines have confi rmed that laparoscopic cholecystectomy is the mainstay of treatment for acute calculous cholecystitis, but the optimal timing of cholecystectomy is still a matter of debate and research. The purpose of the study is to improve the results of surgical treatment of patients with acute obturation calculous cholecystitis by clinical and morphological substantiation of the optimal terms of laparoscopic cholecystectomy.Material and methods. To increase the safety of laparoscopic cholecystectomy, a histological study of micropreparations of the gallbladder wall after laparoscopic cholecystectomy was conducted in 30 patients, who were divided into 2 groups: 1 group – features of morphological and structural changes in the gallbladder wall up to 7 days after the onset of an attack of biliary colic (18 patients; 60 %) and group 2 – peculiarities of the morpho- structural changes of the gallbladder after 7 days from the onset of an acute attack of biliary colic (12 patients, 40 %);The results. On the basis of microscopic examination of histological preparations, it can be stated that in the early stages of the fi rst attack of cholecystitis, acute infl ammation of various morphological types (non-destructive and destructive) occurs in the wall of the gallbladder. In the late period (after 7 days), sclerotic changes develop both in the organ wall and perivesical. The main role in the pathogenesis of the remodeling of the structural components of the gallbladder is played by deep hemodynamic disorders and the prolongation of the infl ammatory process. Circulatory hypoxia, increasing under such conditions, activates the sclerosing process.