[Surgical stress in different cholecystectomies]. / Khirurgicheskii stress pri razlichnykh variantakh kholetsistéktomii.

For determination of surgical stress degree and evaluation of long-term results prospective randomized study was carried out. Three representative groups were compared: patients undergone traditional cholecystectomy (TCE)--95 patients (1 group), laparoscopic cholecystectomy--91 patients (2 group), minimally invasive cholecystectomy--92 patients (3 group). Level of stress hormones (before, during and after surgery), parameters of external respiration (before and after surgery), doses of analgetics (or their combinations) which were necessary for adequate analgesia in early postoperative period depending on surgical method were used as objective criteria of surgical stress. Based on evaluation of patients quality life reliable difference in first three years after surgery between patients undergone TCE and ones undergone minimally-invasive surgery was demonstrated.

[Cholecystectomy by mini-approach in the treatment of cholelithiasis]. / Kholetsistéktomiia iz mini-dostupa v lechenii zhelchnokamennoi bolezni.

Along with wide-spread laparoscopic cholecystectomy, cholelithiasis can be treated with another sparing technique--miniaccess cholecystectomy (MACE). Case histories and long-term treatment outcomes were analysed for 168 patients aged 23-77 years subjected to MACE with elements of open laparoscopy for chronic calculous cholecystitis. Surgery was made using a special surgical kit "Mini-assistant" by the team of two surgeons and an instrument nurse. After MACE the patients resume their jobs after a shorter period of inability, suffer from side effects of surgery in rare cases, have higher quality of life than patients after laparoscopic cholecystectomy.

[Cholecystectomy from mini-approach with the elements of open laparoscopic technique in surgical treatment of cholelithiasis]. / Kholetsistéktomiia iz mini-dostupa s élementami otkrytoi laparoskopicheskoi tekhniki pri khirurgicheskom lechenii zhelchnokamennoi bolezni.

The experience and the technique of cholecystectomy from mini-approach with elements of open laparascopic technique (MSE) in 102 patients with choledocholithiasis and calculous cholecystitis is descubed. In 99 cases the operation was carried out for chronic calculous cholecystitis, in 3 cases--for acute calculous cholecystitis. The patients were aged from 23 to 76 years (mean age 59.3 +/- 3.4 years). The average length of the incision in performing MSE made up 4.1 +/- 0.3 cm. Mean duration of the operation 42.4 +/- 5.3 min. In 5 cases (4.9%) intraoperative cholangiography was performed. The possibility to avoid the use of narcotic analgetics in postoperative period in patients who underwent MSE is demonstrated. Postoperative period made up 3.8 days. Social and cost-effect aspects of different modes of surgical treatment of patients with cholelithiasis are considered. The study of quality of life index makes it possible to come to conclusion about quicker return of the patients who underwent MSE to their habitual social and intellectual activities, practically complete absence of the influence of negative factors of conventional treatment (pains, dyspepsial, cosmetic defects) higher appreciation of their health conditions, well being, which manifests in higher quality of life in operated patients.