Chronic Cholecystitis Research Articles

HPB SO73 - Histopathological Patterns in Emergency and Elective Cholecystectomy

Abstract Background Laparoscopic cholecystectomy (LC) is one of the most frequently performed general surgical procedures. In the United Kingdom, gallbladder specimens are routinely submitted for histopathological analysis to detect occult pathologies, such as carcinoma in situ and early-stage carcinomas. This study aims to assess the results of routine histopathological examination of LC specimens. Method A prospectively collected database of all LCs and laparoscopic common bile duct exploration (LCBDE) performed between August 2022 and June 2024 was analysed. The database was populated from a single benign biliary center by two specialized biliary surgeons. Electronic case notes were analysed for the demographics, indication(s), operative findings and the histopathological results. All gallbladder specimens were sent for histopathology analysis, irrespective of their gross appearance. Results Of the 201 eligible patients, 164 patients had histopathology results available. Median age was 56 years (IQR 41-66) and 100 (61%) were female. 72 (43.9%) were emergency cases. 48 (29.3%) had cholecystectomy, 70 (42.7%) also had intraoperative cholangiogram and 46 (28%) had LCBDE. Conclusion Chronic calculus cholecystitis was the most frequent histopathological finding, followed by acute on chronic cholecystitis and gangrenous acute cholecystitis. Dysplasia was identified in 1.8% of patients, warranting multidisciplinary team discussion. This study underscores the significance of routine histopathological examination after cholecystectomy, as early incidental detection of dysplasia and carcinoma can modify postoperative management and improve patient outcomes.

HPB SO22 - Clinical outcomes following radical cholecystectomies, a single centre experience in review

Abstract Background Gallbladder carcinoma (GBC) is a rare disease with dismal prognosis. The majority of cases are identified at an advanced state that preclude curative approaches which would usually necessitate removal of the gallbladder with en-block wedge hepatectomy of segment 4b/5 as well as periportal lymphadenectomy. The purpose of this study was to analyze our outcomes for patients undergoing a radical cholecystectomy for suspected GBC. Method A retrospective analysis of patients who underwent radical cholecystecomies at Queen’s Medical Centre, Nottingham, UK between 1st January 2014 and October 2023 was performed. Patients with concomitant primaries, incidental GBC or completion liver resection following index cholecystectomy were excluded. Results 41 patients were eligible for analysis, those were comprised of 13 males and 28 females with a median age of 67 (IQR 57-72) years. The incidence of malignancy on histology was 31.7% (GBC n=11, metastatic renal carcinoma n=1, metastatic melanoma n=1). Cystic margin assessment by frozen section was performed in 41% of cases. In cases with confirmed gallbladder cancer, the median tumour size was 30mm, positive periportal lymph nodes were identified in two patients while R0 resection was achieved in all cases. The median length of stay following surgery was 5 days (IQR 5-7) while Clavien Dindo complication grade ≥ III were experienced in 12% ( return to theatre for leak from repaired cholecysto-duodenal fistula n=1, IR drainage of post operative collection n=3, ITU stay for cardiac arrhythmia n=1). The pathologies encountered in benign cases (n=28) were compatible with chronic cholecystitis (53.5%, n=15), concurrent chronic cholecystitis and adenomyomatosis (21.4%, n=6), xanthogranulomatous cholecystitis (10.7%, n=3), adenomyomatosis (7.1%, n=2), follicular cholecystitis (3.5%, n=1), benign GB polyps (3.5%, n=1). Conclusion Radical cholecystectomy remains the standard of care for suspected GBC however sufficient preoperative counselling is prudent given likelihood of benign disease on histology.

Lower Socioeconomic Status Predicts Greater Obstacles to Care: Using Outpatient Cholecystectomy as a Model Cohort.

Patients with low socioeconomic status (SES) are disadvantaged in terms of access to health care. A novel metric for SES is the Distressed Communities Index (DCI). This study evaluates the effect of DCI on hospital choice and distance traveled for surgery. A Florida database was queried for patients with symptomatic cholelithiasis or chronic cholecystitis who underwent an outpatient cholecystectomy between 2016 and 2019. Patients' DCI was compared with hospital ratings, comorbidities, Charlson Comorbidity Index, and distance traveled for surgery. Stepwise logistic regression was used to determine which factors most influenced distance traveled for surgery. There were 54,649 cases-81 open, 52,488 laparoscopic, and 2,080 robotic. There was no difference between surgical approach and patient's DCI group (p = 0.12). Rural patients traveled the farthest for surgery (avg 21.29 miles); urban patients traveled the least (avg 5.84 miles). Patients from distressed areas more often had surgery at one- or two-star hospitals than prosperous patients (61% vs 36.3%). Regression indicated distressed or at-risk areas predicted further travel for rural/small-town patients, while higher hospital ratings predicted further travel for suburban/urban patients. Compared to prosperous areas, patients from distressed areas have surgery at lower-rated hospitals, travel further if they live in rural/small-town areas, but travel less if they live in suburban areas. We postulate that farther travel in rural areas may be explained by a lack of health care resources in poor, rural areas, while traveling less in suburban areas may be explained by personal lack of resources for patients with low SES.

Acute abdominal pain with surprising etiology-rare complication of a common disease

The development of a cholecystocolic fistula as a complication of chronic cholecystitis and/or cholangitis is very rare and is difficult to detect without modern imaging. Nevertheless, acute abdominal symptoms are a frequent cause of patient presentation to an emergency department. The present case demonstrates that chronic cholecystitis with corresponding complications can present even without cholestasis and infection.

Endoscopic Findings of a Patient Having Cholelithasis in SOMCH, Sylhet, Bangladesh

Introduction: Cholelithiasis is one of the most frequently encountered disease and one of the major causes of abdominal morbidity throughout world [1]. Cholelithiasis is one of the most common and costly of all digestive diseases. Common causes of upper abdominal symptoms are peptic ulcer, acute and chronic gastritis and gallstones. Objective: To assess the endoscopic findings of a patient having cholelithasis in SOMCH. Methods: This was Retrospective Hospital based study conducted at Department of Surgery, Sylhet MAG Osmani Medical College Hospital, Sylhet, Bangladesh from January to December 2022 were (One hundred patients were included). All patients underwent OGD after being diagnosed as having cholelithiasis proved by Endoscopic. All patients above 18 years of age presenting with upper abdominal pain, dyspepsia with or without jaundice diagnosed ultrasonically as cholelithiasis and choledocholithiasis with cholelithiasis were included in the study and patients managed conservatively, patients with primary choledocholithiasis and with asymptomatic gallstones were excluded from the study. Results: Out of 100 subjects evaluated during the study period, 58 were females and 42 males. The most common age group affected was between 31-50 years (65%), followed by less than 30 years of age being 18% and more than 50 years being 17%. It should also be noted the higher rate of incidence (65%) in the age group of 31-50 years. Associated symptoms with cholelithiasis were pain in abdomen, which was observed in all the patients (100%). Of these, 74 patients (74%) presented with chronic upper abdominal pain and 26 patients (26%) presented with acute upper abdominal pain. Remaining 56% of the subjects had positive endoscopic findings. Endoscopic findings were positive in 56 had hiatus hernia, duodinitis, duodenal ulcer or other positive findings. Among patients with positive findings 14 had both oeophagitis as well as gastritis while 12 had both gastritis as well as gastric ulcer. All the 56 patients (100%) underwent surgery. Forty patients (71.4%) underwent laparoscopic cholecystectomy, 14 (25.0%) open cholecystectomy and 2 cholecystostomy for empyema gall bladder. Of the 56 patients 40 patients (71.4%) patient had chronic cholecystitis, 9 patients (16.07%) had acute cholecystitis, 4 patients (7.14%) had carcinoma gall bladder, 2 (3.57%) had xanthogranulomatous cholecystitis and 1(1.78%) had cholesterolosis of gallbladder. Of the 4 patients diagnosed of carcinoma gallbladder, 1 patient had carcinoma confined to muscularis mucosa with negative margins and no metastasis, hence no further surgical management was advised and the rest of the 3 patients had either metastasis or positive margins which were managed as per standard guidelines. Conclusion: Cholelithiasis is commonly seen in females in 4th and 5th decade mainly presenting with abdominal pain and dyspepsia. Endoscopy the most common finding was gastritis, oesophagitis and gastric ulcer in decreasing order. There was no hiatus hernia, duodinitis or duodenal ulcer in our study. Patients presenting with dyspepsia and gall-stones in rural setup should be directly treated surgically. Multiple gallstones are common and Laparoscopic cholecystectomy offers best surgical management with 6.57% of conversion rate to open cholecystectomy, with lesser complications.

Negative 18F-FDG and Positive 68Ga-FAPI-04 Findings in a Patient With Acute Exacerbation of Chronic Cholecystitis.

Acute cholecystitis typically exhibits intense FDG uptake of the gallbladder wall. Radiolabeled fibroblast activation protein inhibitor (FAPI) is considered as a potential alternative agent for tumor-specific imaging. We report 18F-FDG and 68Ga-FAPI-04 PET/MR findings in a 44-year-old woman with acute exacerbation of chronic cholecystitis. The lesions show negative 18F-FDG uptake but intense 68Ga-FAPI-04 uptake in PET/MR. This case highlights the imperative for nuclear medicine clinicians to exercise vigilance when evaluating gallbladder lesions exhibiting intense 68Ga-FAPI-04 but negative 18F-FDG uptake.

Altering Trends in Pathological Spectrum of Cholecystectomy Specimen: Time to be More Vigilant

Abstract Background: Gall bladder cancer is a rare, most common and aggressive malignancy of the biliary tree, accounting for 80%–90% of biliary tract cancers. Gallstones are one of the major causes of the development of cholecystitis and long-term malignancy in developing countries. Cholecystectomy specimens have a great value in documenting various entities with clinical significance. Early detection is the most important step in improving the prognosis of gall bladder carcinoma (GBC) screening. Aim: Clinico- pathological spectrum of cholecystectomy specimen and Incidence of malignancy and its precursor lesion with gallstones. Patient and Methods: We conducted a retrospective analysis of all gall bladder specimens (cholecystectomy, laparoscopic, open or radical) from the period of January 2019–January 2022, including demographic data of the patients such as age and sex. Additional findings, such as the presence of gallstones, cholesterolosis, gastric or intestinal metaplasia, dysplasia and histopathological type of GBC, were documented. Results: A total of 1221 gall bladder specimens were received, with a higher female preponderance and a female-to-male ratio of 2.6:1. The mean age of presentation was 45 years. The most common histopathological diagnosis made was chronic cholecystitis (97%), and malignant cases accounted for 3% of the total cases. Conclusions: The high propensity of GBC with non-cholelithiasis cases, more than half of cases with metaplasia and increased incidence of adenosquamous carcinoma indicate a high burden of tumours, alerting the clinician as well as the pathologist.

Dynamics of anxiety individuals with chronic calculous cholecystitis before and after cholecystectomy under the influence of a rehabilitation program in the acute period of rehabilitation

Dynamics of anxiety individuals with chronic calculous cholecystitis before and after cholecystectomy under the influence of a rehabilitation program in the acute period of rehabilitation

The incidence of complications in Laparoscopic Cholecystectomy in Acute Cholecystitis in tertiary Care Setup

Abstract Laparoscopic cholecystectomy is the procedure usually performed in our setups for both acute & chronic Cholecystitis and simple gall stone disease. Objective Find the outcomes of laparoscopic cholecystectomy in acute cholecystitis in our hospital setup. Methods This prospective cross sectional study was conducted in Hazrat Bari Sarkar Hospital Islamabad on 10th Nov 2022 to 30 June 2023. The patients from above 10 year age with both genders were included by convenient sampling. All Diagnosed cases of gall stone disease with acute cholecystitis, acute on chronic cholecystitis, abscess, and empyema or mucocele gall bladder were included in this study. SPSS 22 was used for data analysis that was recorded on a performa. Results This study included 77 laparoscopic cholecystectomies done for Acute Cholecystitis. 53 female & 24 male patients with female to male ratio of 2.2:1 undergoing laparoscopic cholecystectomies were included in the study. The mean age of patients was 47.6 years + 11.6 SD. The mean operative time was around 90min + 13.5 SD and the mean hospital stay was 2.23 days + 0.77 SD with a range of 1-4 days. Conversion rate to open cholecystectomy was noted in 8 cases. The operative complications were bleeding in 2 cases, minor bile duct injury in 2 cases, surgical site infection 15 cases, retained stone in 2 cases. Conclusion Laparoscopic cholecystectomy for acute cholecystitis has better results in patient outcomes as regards post-operative recovery & length of hospital stay & safety.

ThP5.9 - Evaluation of cholecystectomy service in a general NHS hospital

Abstract Background Cholecystectomy is commonly performed for biliary pathologies, as elective, emergency, or at prioritised basis (Hot Gall bladder service). Aim Evaluating local performance of cholecystectomy, outcomes and areas for improvement. Results Over a 4-week period, 38 cholecystectomies were performed, all laparoscopically. Almost half had cholecystitis or cholangitis requiring at least 1 admission with 5 patients required more than 1 admission in 12 months prior to surgery. 50% of cholecystectomies were done in 6 months, while the longest waiting time was 13 months. 50% of procedures were done electively, whereas the rest in emergency and hot gall bladder lists. Indications included acute cholecystitis (13), biliary colic (11), chronic cholecystitis (6), biliary pancreatitis (4), GB polyps (3) and CBD stones (1). Only 2 had subtotal cholecystectomy, and Nassar operative difficulty was graded as one in 18, two in 15, three in 4 and four in 1 of the cases. Critical view of safety was obtained in 85% and biliary anatomy was unusual in 12 cases. Operative cholangiogram and CBD exploration were performed in 5 and 8 cases respectively. Complications included bile spillage (12/38), and bleeding (7/38). 30-day follow up showed 16 patients were discharged in 24 hours and only 3 readmitted. The incidence of complications was 37%, 11 cases had SSI and 3 had pulmonary complications). No bile leak or CBD injury. All specimens were sent for examination showing benign histology. Recommendation Emergency and hot cholecystectomy services not only cut down waiting lists but also reduce costs of reoccurring admissions, with no significant added complications. Selective gall bladder histological examination may reduce costs with no recognised risks.

SP1.7 - Cholecystectomy in Children: Tertiary Institutional Review of 10-years

Abstract Aim This study evaluates cholecystectomy necessity in pediatric patients with gallstones, correlating clinical symptoms, diagnostic imaging, histological findings, and postoperative outcomes. Method A decade-long (2013-2023) retrospective analysis at our tertiary Pediatric institution focused on patients aged 0-16 years undergoing cholecystectomy. Data from electronic patient records included demographics, preoperative symptoms, ultrasound findings, liver function tests, associated health conditions, surgical techniques, and postoperative developments. Results Our review encompassed 52 patients (35/52 females). Their ages ranged from 3 to 16 years (median = 13). Recurrent abdominal pain was the predominant symptom, reported in 49 patients. A minority (3 patients) were asymptomatic. 18 patients exhibited jaundice, while 5 cases each were associated with pancreatitis and cholecystitis, both clinically and biochemically. Comorbid conditions were identified in 24 patients, including sickle cell disease (15 cases), hereditary spherocytosis (6 cases), and metachromatic leukodystrophy (3 cases). Ultrasound findings revealed gallstones in 48 out of 52 patients, with the remaining 4 (3 metachromatic leukodystrophy) showing no stones. Histologically, cholecystitis was confirmed in 32 patients, but gallstones were only verified in 34 cases. Laparoscopic cholecystectomy was performed in 49 cases, and 13 of these also involved splenectomy. In 3 cases, laparoscopy was converted to open surgery due to splenectomy-related factors. During follow-up, 2 patients reported recurrent symptoms. One of these, initially diagnosed with chronic cholecystitis, was later found to have irritable bowel syndrome. Another patient required subsequent splenectomy. Conclusion Our study reveals a notable disparity between preoperative ultrasound findings and histological results. Nevertheless, cholecystectomy remains a safe and effective intervention in judiciously selected symptomatic paediatric patients, with most experiencing symptom resolution post-surgery.

WP4.16 - Gallstone ileus as an infrequent cause of bowel obstruction- a review of small cohort

Abstract Introduction It is uncommon cause of small bowel obstruction, presents 1 – 5% of adult population. It is a rare complication of chronic cholecystitis which lead to cholecysto-enteric fistula and impaction of gall stone in GI tract leading to mechanical bowel obstruction. Our aim is to report the natural history and management of this condition in District Hospital. Method Retrospective 10 years of data was collected with CT findings of intestinal obstruction with gall stone ileus. It included 10 patients over 10 years whose medical records were evaluated retrospectively. Results Majority of patients were female (90%, n:9) with mean age of 81.6 years (range 61-96) although 90% of population were above 70 years. Presenting complaints were mostly pain and vomiting. Onset of symptoms between 2- 7 days. The site of obstruction was mostly ileum (n=9) with exception of one case in sigmoid proximal to stricture and size of stone was ranging ffrom2.5 to 4 cm, moreover most of the patients had previous history of gall stone (n=7) with one post cholecystectomy status. During routine investigations 50 % of patients had deranged LFT &AKI and 50-60% had raised inflammatory markers (WBC,CRP).Intervention as Enterolithotomy was the preferred approach (n=8,2 lap ,7 open) and non operative management was performed in two cases.The mean post op length of stay were 10 days in open and 5 days in Lap respectively. Conclusions Elderly female patients are more prone to have gallstone ileus particularly with a past medical history of gall stone and the preferred management option is Enterolithotomy which could be open or laparoscopic depending on expertise of the Surgeon.

A Comparative Study of Laparoscopic Versus Robotic Cholecystectomies Based on the Parkland Grading Scale.

Background Cholecystectomy, the surgical removal of the gallbladder, is a common procedure performed to treat conditions like gallstone disease and cholecystitis. Among the various techniques available, laparoscopic cholecystectomy (LC) and robotic cholecystectomy (RC) are minimally invasive methods, while open cholecystectomy (OC) involves a more extensive incision and is reserved for cases where less invasive options are unsuitable. This study focuses on evaluating and comparing the safety and efficacy of LC and RC across different grades of cholecystitis, categorized by the Parkland Grading Scale. The goal is to determine whether RC provides significant benefits over LC, particularly in cases of higher-grade cholecystitis. Methodology This ambispective observational case-control study was conducted from January to June 2024 at Manipal Hospitals, Vijayawada, India. It included patients aged 18 or older with acute cholecystitis who underwent LC or OC. Exclusions were made for chronic cholecystitis, prior surgeries affecting the procedure, incomplete records, or severe complications. Data, including demographics, preoperative symptoms, intraoperative details, and postoperative outcomes, were extracted from electronic medical records. Laparoscopic procedures used standard techniques, while robotic procedures employed the da Vinci surgical system. Outcomes measured included operative time, complications, conversion rates, length of stay, and readmission rates. Results There was no significant difference in pre-operative parameters like age, white blood cell (WBC) count, total bilirubin, alanine transaminase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), or history of previous surgery according to the Parkland Grading Scale. However, differences were noted in the Parkland Grading Scale regarding the thickness of the gallbladder wall, incidence of pericholecystic collection, and history of acute cholecystitis (p < 0.05). The most common complication was bleeding during the operation, which was more frequent in LC and was significant. Other complications, such as bile duct injury and vascular injury, were not observed in either procedure. Conclusion This study highlights that RC provides notable benefits compared to LC, especially for higher grades of cholecystitis, as per the Parkland Grading Scale. Although robotic procedures have longer operative times, they result in fewer intraoperative and postoperative complications, reduced conversion rates, and lower readmission rates. These advantages make RC a promising choice for treating complex cases of cholecystitis.

Examination of the thickness of the different components of gallbladder wall in cases with mucocele and/or cholecystitis.

To assess the thickness of each layer of the gallbladder wall with different diseases in dogs. 72 gallbladders. Retrospective study of dogs that underwent cholecystectomy. Histopathological specimens of the gallbladders were reviewed. Histopathological diagnosis was made as gallbladder mucocele or cholecystitis, and cholecystitis was further categorized into chronic cholecystitis, acute-on-chronic cholecystitis, acute cholecystitis, and necrotic cholecystitis. The thickness of each layer of the gallbladder wall was measured. 22 dogs were diagnosed with gallbladder mucocele without cholecystitis, 24 with gallbladder mucocele and cholecystitis, 20 with only cholecystitis, and 6 as normal. Histopathological subclassification of cholecystitis in 44 gallbladders led to diagnosis of chronic cholecystitis in 21 gallbladders, acute-on-chronic cholecystitis in 10 gallbladders, acute cholecystitis in 6 gallbladders, and necrotic cholecystitis in 7 gallbladders. The thickness of the entire wall of the gallbladder (P < .0001) and the thickness of the mucosa (P < .0001) and subserosa (P < .0001) were affected by the different disease processes. Layers of the gallbladder wall were affected by diseases present in the gallbladder. It resulted in a difference in the thickness of the wall of the gallbladder among the gallbladder diseases in this study. Histopathological changes should be taken into consideration before surgery while deciding what technique to use to perform a cholecystectomy.

Simultaneous Surgery and Management in Patients with Chronic Cholecystitis and Gynecological Diseases

Simultaneous Surgery and Management in Patients with Chronic Cholecystitis and Gynecological Diseases

Helicobacter Pylori and Metaplastic Changes in Chronic Cholecystitis: A Correlation Study

Abstract Introduction: Various types of metaplastic changes, such as gastric metaplasia (foveolar type or antral type) and intestinal metaplasia, are observed in chronic cholecystitis but not in normal mucosa. Helicobacter species can be detected in the bile and gallbladder tissue of patients with benign gallbladder disease. Objective: The present study aimed to observe the correlation between chronic cholecystitis and the presence of Helicobacter pylori as well as the different types of metaplastic changes in gallbladder mucosa. Materials and Methods: This descriptive, observational study was conducted at the Departments of Pathology and Surgery at a tertiary care medical college and hospital from April 2021 to March 2022, using a cross-sectional design. All confirmed cases of chronic cholecystitis, with or without cholelithiasis, were included in the study. Results: Intestinal metaplasia was the most common type of metaplastic change in the gallbladder epithelium in chronic cholecystitis in this region. PAS and Alcian Blue positivity were significantly higher in cases with metaplasia compared to those without metaplasia. H. pylori was detected in 3 cases (1.55%) of chronic cholecystitis in this study population. Conclusion: Mucin histochemistry may help identify early metaplastic changes in gallbladder epithelium. The use of a combination of methods for the detection of H. pylori in gallbladder tissue may increase the detection of positive cases.

HER2/ERBB2 overexpression in advanced gallbladder carcinoma: comprehensive evaluation by immunocytochemistry and fluorescence in situ hybridisation on fine-needle aspiration cytology samples

AimsAdvanced gallbladder carcinoma (AGBC) carries a poor prognosis with dismal survival. There are no data regarding HER2/ERBB2 expression in AGBC. This study evaluated the overexpression of HER2/ERBB2 in cytological aspirates...

Improvement of Single-port Laparoscopic Cholecystectomy

The desire of both surgeons and patients to reduce the trauma of the operation and shorten the length of hospital stay, on the one hand, and on the other hand, the development of new technologies and the emergence of special devices led to the development and implementation of video endoscopic minimally invasive methods of surgical intervention. The results of single-port laparoscopic cholecystectomy and the possibility of choosing instrumental support when performing these operations should be analyzed. Our study included 116 patients hospitalized for planned surgical treatment with chronic calculous cholecystitis from 2019 to 2023. The patients were divided into two groups: the first main group consisted of 52 (44.8%) patients with chronic calculous cholecystitis who underwent single-port laparoscopic cholecystectomy (SLP) using the single access technique (SAL). The second group (TLCE) consisted of 64 (55.2%) patients with CCC who underwent laparoscopic four-port cholecystectomy. A comparative analysis of the results of the intraoperative and early postoperative periods in patients after TLCE using the single access method, the number of complications was minimal than with TLCE using a four-port approach. Long-term results of surgical treatment of patients with cholelithiasis after OLCE using the single access method are characterized by the least complications, high cosmetic effect, and low morbidity.

Features of Performing Single-port Laparoscopic Cholecystectomy

The advantages of endoscopic surgery are well known, which has been confirmed by domestic and world experience in the use of minimally invasive technologies. Along with this, the widespread introduction of operative laparoscopy has led to complications specific to this technology. When performing laparoscopic operations, 3 to 6 trocars are inserted into the abdominal cavity. A large number of undesirable consequences of the introduction of trocars into the abdominal cavity, the so-called trocar complications (iatrogenic damage to internal organs, blood vessels, extraperitoneal insufflation, development of trocar hernias with deterioration of the aesthetic result, increased postoperative pain, increased risk of complications associated with the occurrence of hematomas, wound infections), served as the basis for the search for less invasive techniques. The rapid development of endoscopic surgery has contributed to the emergence of a wide range of surgical methods that do not leave gross scar changes on the skin of the anterior abdominal wall. These include single-port laparoscopic cholecystectomy, which reduces trauma to the anterior abdominal wall and improves cosmetic results. The clinical significance of the single laparoscopic approach (SLA) technique in the surgical treatment of patients with chronic calculous cholecystitis should be substantiated. The study included 116 patients hospitalized for planned surgical treatment with a diagnosis of gallstone disease. Chronic calculous cholecystitis” from 2019 to 2023 on the basis of the National Chemical Center named after M.M. Mamakeev of the Ministry of Health of the Kyrgyz Republic, Bishkek. The use of a single laparoscopic access technique for removing the gallbladder with proper selection of patients and strict adherence to methodological and technical principles makes it possible to achieve better results in the treatment of patients with cholelithiasis with access along the upper edge around the navel than with a longitudinal transubial approach.

Indicators of Central Hemodynamics During Simultaneous Laparoscopic Operations in the Combination of Chronic Calculous Cholecystitis and Gynecological Diseases

Currently, a combination of various surgical and gynecological pathologies in one patient is not uncommon. In this regard, performing simultaneous operations seems to be a more optimal method of choice. After all, the main advantage of simultaneous operations is the ability to reduce the load on the patient’s body and simultaneously perform two or more different interventions, which helps reduce treatment and recovery time. Under observation were 197 patients who underwent simultaneous operations in the period from 2019 to 2023. The studies were carried out on the basis of the National Clinical Center of the Ministry of Health of the Kyrgyz Republic, the MC KG private clinic and the Medi private clinic.