ABSTRACT
AIM: To define causes of difficult situations in various forms of acute cholecystitis depending on terms of disease and clinico-morphological changes in gall bladder area and to justify differentiated application of laparoscopic surgery for acute cholecystitis. MATERIAL AND METHODS: It was reviewed 1132 medical records of patients with acute cholecystitis. It is found that morphological changes in gall bladder and surrounding tissues depend on duration of follow-up of patients with acute cholecystitis and type of inflammation. RESULTS: In acute catarrhal cholecystitis "complicated" intraoperative situations are observed in 37.5% due to "loose" tissues infiltration, in phlegmonous and gangrenous forms of inflammation - in 44.6% and 63.6% respectively due to "dense" infiltrates development. CONCLUSION: Technical variants of laparoscopic cholecystectomy for various "difficult" intraoperative situations are suggested.
Subject(s)
Cholecystectomy, Laparoscopic , Cholecystitis, Acute/surgery , Gallbladder , Intraoperative Complications , Cholecystectomy, Laparoscopic/adverse effects , Cholecystectomy, Laparoscopic/methods , Cholecystitis, Acute/pathology , Cholecystitis, Acute/physiopathology , Female , Gallbladder/pathology , Gallbladder/physiopathology , Gallbladder/surgery , Humans , Inflammation , Intraoperative Complications/diagnosis , Intraoperative Complications/etiology , Intraoperative Period , Male , Middle Aged , Outcome and Process Assessment, Health CareABSTRACT
A frequent combination of cholecystitis and reflux-esophagitis is noted (from 20% to 60%). Pathogenetical mutual interdependence of these diseases was found. At the same time, reflux-esophagitis is not diagnosed and not corrected by surgical treatment of cholecystitis. The frequency of reflux-esophagitis not corrected during cholecystectomy is increased in the structure of "postcholecystectomy syndrome". The article gives an analysis of operative treatment of 438 patients with cholecystitis. In 265 of them only cholecystectomy was performed, in 173--cholecystectomy and fundoplication after Nissen. A comparison of immediate and remote results of the both groups has shown that most favorable results were obtained after simultaneous operations which results in reduced frequency of "postcholecystectomy syndrome" by 30%.
Subject(s)
Cholecystitis/diagnosis , Esophagitis, Peptic/diagnosis , Cholecystectomy , Cholecystitis/complications , Cholecystitis/surgery , Cholelithiasis/complications , Cholelithiasis/diagnosis , Cholelithiasis/surgery , Combined Modality Therapy , Diaphragm/surgery , Esophagitis, Peptic/etiology , Esophagitis, Peptic/surgery , Esophagus/surgery , Hernia, Hiatal/complications , Hernia, Hiatal/diagnosis , Hernia, Hiatal/surgery , Humans , Stomach/surgeryABSTRACT
In the recent years the number of patients with cholelithiasis has been increasing. The absolute majority of the patients are admitted to hospitals for urgent indications. Elderly patients with long histories, complications and concomitant diseases prevail. Not only the disease but complications as well must be exactly diagnosed. On the basis of the experience with 1298 operations on biliary ducts (178 of them subjected to choledochoduodenal anastomosis) the authors have determined the following indications for choledochoduodenal anastomosis: choledocholithiasis and dilated bile duct over 1,5 cm in diameter, cleavage of concrements in the bile duct, uncertainty of complete sanitation of the dilated duct and constricted terminal end of the choledochus with a concomitant pancreatitis. A one-row suture and the Yurash-Vinogradov method of choledochoduodenal anastomosis are preferred.
