Surgery

doi: 10.25005/2074-0581-2019-21-1-121-128
RESULTS OF EMERGENCY LAPAROSCOPIC CHOLECYSTECTOMY IN PATIENTS WITH HIGH OPERATIONAL RISK

F.I. Makhmadov1,2, D. Mirbegiev1, P.Sh. Karimov1, Kh.Sh. Makhmadyorov1

1Department of Surgical Diseases № 1, Avicenna Tajik State Medical University, Dushanbe, Republic of Tajikistan
2Istiklol Medical Complex, Dushanbe, Republic of Tajikistan

Objective: To study the results of emergency laparoscopic and traditional cholecystectomy in patients with high operational risk.

Methods: The results of surgical treatment of 132 patients with acute calculous cholecystitis with high operational risk were studied, in particular: advanced age – 34.8% (n=46); Grade III-IV obesity – 24.3% (n=32); history of abdominal operations – 18.2% (n=24); “difficult” gallbladder – 22.7% (n=30). Conducted clinical, laboratory and instrumental methods of research. In 89 (67.4%) cases, emergency laparoscopic cholecystectomy (LCE) was performed, in 43 (32.6%), emergency traditional cholecystectomy was performed.

Results: All urgent LCEs are distributed according to the degree of complexity according to the classification of LCE classes according to Iannet. Not one of the interventions, of the main group of patients did not correspond to the “simple” class of LCE. 87 (97.8%) cases were related to “complex” LCE when technical difficulties arose at different stages of the operation: with the imposition of pneumoperitoneum and the installation of trocars in patients with obesity (n=24) and with the adhesive disease after suffered abdominal operations (n=16). “Dangerous” LCE was noted in 2 (2.2%) cases of Mirizzi type II syndrome, which required conversion with intraoperative choledochoscopy. In 43 observations, an open cholecystectomy was produced, of which, in 62.6% of cases non-standard techniques have been implemented: Pribram cholecystectomy (n=11), “from the bottom” (n=5) and the “piece-breaking” method (n=5). After performing open interventions, 7 (16.3%) patients experienced postoperative complications with a lethal outcome (2.3%). In LCE, complications were observed in 11.2% of cases in the form of bleeding from the gallbladder bed (n=6) and bile leakage through the control drainage (n=4). In the postoperative period after LCE, one patient (1.1%) died of pulmonary embolism.

Conclusions: The application of the proposed techniques allows reducing the duration of the operation, reducing the number of intra- and postoperative complications and, thereby, improving the results of surgical treatment of this heavy contingent of patients.

Keywords: Cholelithiasis, acute calculous cholecystitis, emergency laparoscopic cholecystectomy, adhesive disease.

Download file:


References
  1. Kurbonov KhKh, Abdulloev DD, Fayzullaev AKh, Zukhurov KhD. Vozmozhnosti luchevykh metodov issledovaniya v diagnostike ostrogo kal’kulyoznogo kholetsistita [Features of radiological methods in diagnostics of calculous cholecystitis]. Vestnik Avitsenny [Avicenna Bulletin]. 2015;2:47-51.
  2. Ukhanov AP. Ispol’zovanie laparoskopicheskoy kholetsistektomii pri lechenii zhyolchnokamennoy bolezni i ostrogo kholetsistita u bol’nykh s sakharnym diabetom [The use of laparoscopic cholecystectomy in the treatment of gallstone disease and acute cholecystitis in patients with diabetes]. Endoskopicheskaya khirurgiya. 2012;6:7-11.
  3. Germanovich ChS. Vlizanie rubtsovo-vospalitel’nogo protsessa na rezul’taty lecheniya bol’nykh s kal’kulyoznym kholetsistitom [Influence of scarinflammatory process on the results of treatment of patients with calculous cholecystitis]. Endoskopicheskaya khirurgiya. 2009;3:12-4.
  4. Paajanen H, Kakela P, Suuronen S, Paajanen J, Juvonen P, Pihlajamaki J. Impact of obesity and associated diseases on outcome after laparoscopic cholecystectomy. Surg Laparosc Endosc Percutan Tech. 2012;22:509-13.
  5. Makhmadov FI, Kurbonov KM, Rafikov SR, Kuzratov FKh. Nekotorye laparoskopicheskie podkhody v khirurgii «trudnogo» zhyochnogo puzyrya [Some laparoscopic approaches in surgery of the «difficult» gallbladder]. Izvestiya Akademii nauk RT. 2013;3-4:49-55.
  6. Beburishvili AG. Zavershayushchiy etap laparoskopicheskoy kholetsistektomii pri perivezikal’nykh oslozhneniyakh gangrenoznogo kholetsistita [The final stage of laparoscopic cholecystectomy in perivesical complications of gangrenosis cholecystitis]. Endoskopicheskaya khirurgiya. 2010;6:7-11
  7. Ukhanov AP. Ispol’zovanie laparoskopicheskoy kholetsistehktomii pri lechenii destruktivnykh form ostrogo kholetsistita u bol’nykh starshikh vozrastnykh grupp [The use of laparoscopic cholecystectomy in the treatment of destructive forms of acute cholecystitis in patients of older age groups]. Endoskopicheskaya khirurgiya. 2012;2:16-20
  8. Tiong L, Oh J. Safety and efficacy of a laparoscopic cholecystectomy in the morbid and super obese patients. HPB. 2015;17:600-4
  9. Timerbulatov MV, Khafizov TN. Khirurgicheskaya korrektsiya rannikh posleoperatsionnykh oslozhneniy laparoskopicheskoy kholetsistektomii [Surgical correction of early postoperative complications of laparoscopic cholecystectomy]. Endoskopicheskaya khirurgiya. 2010;1:25-7
  10. Teremov SA, Mukhin AS. Redkaya anomaliya treugol’nika Kalo pri laparoskopicheskoy kholetsistehktomii [Rare anomaly of the Kahlo triangle with laparoscopic cholecystectomy]. Endoskopicheskaya khirurgiya. 2011;2:12-3.
  11. Makhmadov FI, Kurbonov KM, Kuzratov FKh, Rafikov SR. Nestandartnye laparoskopicheskie kholetsistektomii pri ostrom kal’kulyoznom kholetsistite u bol’nykh starshikh vozrastnykh grupp [Non-standard laparoscopic cholecystectomy for acute calculous cholecystitis in patients of older age groups]. Vestnik pedagogicheskogo universiteta. 2014;5:241-6.
  12. Rakhmatullaev AR, Artykov KP, Rakhmatullaev RR. Laparoskopicheskie simul’tannye operatsii pri sochetannykh khirurgicheskikh zabolevaniyakh organov bryushnoy polosti [Laparoscopic simultaneous operations in combined surgical abdominal diseases]. Vestnik Avitsenny [Avicenna Bulletin]. 2016;1:21-4.
  13. Kuznetsov YuN. Endokhirurgicheskie tekhnologii v lechenii ostrogo kholetsistopankreatita [Endosurgery technologies in acute cholecystopancreatitis treatment]. Rossiyskiy mediko-biologicheskiy vestnik im. akademika I.P. Pavlova. 2004;1-2:138-42.

Authors informations:

Makhmadov Farukh Isroilovich , Doctor of Medical Sciences, Professor of the Department of Surgical Diseases № 1, Avicenna Tajik State Medical University; First Deputy Director of the Istiklol Medical Complex

Mirbegiev Dzhamshed , Competitor of the Department of Surgical Diseases № 1, Avicenna Tajik State Medical University

Karimov Paymon Shodmonkhudzhaevich , Postgraduate Student of the Department of Surgical Diseases № 1, Avicenna Tajik State Medical University

Makhmadyorov Khayom Shavkatovich , Postgraduate Student of the Department of Surgical Diseases № 1, Avicenna Tajik State Medical University

Address for correspondence:

Makhmadov Farukh Isroilovich
Doctor of Medical Sciences, Professor of the Department of Surgical Diseases № 1, Avicenna Tajik State Medical University; First Deputy Director of the Istiklol Medical Complex

734003, Republic of Tajikistan, Dushanbe, Rudaki Ave., 139

Tel.: +992 (900) 754490

E-mail: fmahmadov@mail.ru

Materials on the topic: