Procedure of surgery treatment method choice in patients with acute cholecystitis with high anesthetic risk

Abstract

Background. Research objective is efficiency assessment of laparoscopic cholecystectomy (LCE) with fan-shaped laparolift and sustainable development of the algorithm of surgical treatment of acute calculous cholecystitis in patients with increased anesthetic risk. Methods. The results of treatment of 154 patients aged 43-87 with acute cholecystitis were summarized. In 78 cases the LCE was carried out in gas-free environment using laparolifta own design (the study group), 76 cases of LCE performed under carboxyperitone-um at a pressure of 6-8 mm/Hg. For objectification of assessing the severity of the general condition used SAPS II - Simplified Acute Physiology Score. Results. The median SAPS II in the study group was 31.9±1.6, the control - 29.8±1.4 points. The estimated risk of death in patients of the study group amounted to 9.5±0.6 %, which was 0.9 % less than in control group. The number of post-surgery complications when using fan-shaped laparolift was 27.3 % lower. In the control group mortality was 6.6 % (5 patients) in the group where LCE was performed with the use of fan-shaped laparolift, one person died (fatality rate 1.3 %). conclusions. Determining the severity of the general condition of SAPS II with the calculation of the prognostic index of hospital mortality at admission helps to choose the most rational method of surgery treatment of acute destructive cholecystitis in patients with increased anesthetic risk.