Experience of treating patients with complicated forms of gallstone disease on the background of liver cirrhosis

Abstract

Annotation. In recent years, further improvement of minimally invasive surgical interventions has been noted. Surgical treatment of complicated gallstone disease has become quite standardized all over the world. However, accompanying cirrhosis of the liver remains the most severe comorbid condition. The purpose of this study is to determine the optimal treatment strategy of this category of patients. We analyzed the results of surgical treatment of 79 patients with complicated forms of gallstone disease and concomitant liver cirrhosis. All patients were conditionally divided into 2 groups: a control group of patients who were treated according to the standard program – 38 patients and the main group of patients who were treated using an improved diagnostic and treatment program – 41 patients. The patients of the retrospective group underwent a standard diagnostic and treatment program according to the recommendations for diagnosis and treatment of patients with complicated forms of gastrointestinal tract with correction of hepatorenal insufficiency. Since 2016, an updated diagnostic and treatment algorithm has been introduced in patients with complicated forms of gastrointestinal tract against the background of liver cirrhosis. All patients underwent a balanced approach in the analysis of manifestations of liver cirrhosis, which manifested itself in the introduction of the principles of controlled antibacterial therapy according to the level of C-reactive protein; differentiated implementation of thromboprophylaxis: according to the standard scheme and early postoperative thromboprophylaxis based on the risks of hemorrhagic complications. The results of this research were statistically analyzed using chi-square test and statistical comparison of both groups. According to the results of a comparative analysis of the results of the treatment of patients in both groups was performed, it was established that postoperative complications occurred both in patients of the main group and in the comparison group. However, the frequency of occurrence of complications in the groups of studied patients has a significant difference. In the main group, complications were 14.6% versus 34.2% (in the comparison group) at p≤0.05 (χ2=4.14), which indicates that the improved diagnostic and treatment program made it possible to significantly reduce postoperative complications, and the outcome of treatment of patients with complicated forms of gallstone disease.