Surgery
doi: 10.25005/2074-0581-2020-22-2-269-274
FEATURES OF TREATMENT TACTICS FOR PATIENTS WITH «HIGH RISK» ACUTE OBSTRUCTIVE CHOLECYSTITIS

D.A. Abdullozoda1,2, L.A. Gulomov1, A.M. Safarzoda3

1Department of General Surgery № 2, Avicenna Tajik State Medical University, Dushanbe, Republic of Tajikistan
2Istiklol Health Complex, Dushanbe, Republic of Tajikistan
3Department of General Surgery № 1, Avicenna Tajik State Medical University, Dushanbe, Republic of Tajikistan

Objective: To improve the results of surgical treatment of patients with high operational and anesthetic risk, the suffering of acute obstructive cholecystitis (AOC), by improving two-stage tactics.

Methods: From 2015 to 2019, 158 patients with AOC who had several concomitant diseases or a long period of the main pathology before hospitalization were subjected to surgical treatment. The age of patients ranged from 50 to 90 years. Patients were divided into 2 groups: the first group (control) – 74 (46.8%) patients who underwent decompression of the biliary system through cholecystostomy for 3 to 10 days; the second group (main) – 84 (53,2%) patients who, in addition to the above manipulations, underwent intracystic laser therapy through cholecystostomy.

Results: All patients with AOC who had a high operational and anesthetic risk were subjected to a two-stage surgical tactic, which consisted of cholecystic decompression (first stage) followed by cholecystectomy (second stage). Group I patients received the generally accepted two-stage tactics followed by traditional cholecystectomy. Patients of group II at the second stage underwent laparoscopic cholecystectomy. Intraoperative complications in patients of group I: bleeding – 2.63%, iatrogenic damage to the common bile duct – 0.1%. In the postoperative period, seroma observed in 14.3% of cases, postoperative wound infiltrate in 11.9%, suppuration in 9.52%, peritonitis in 1.76% (required re-operation). The lethality in this group was 4.05% (3 cases). No intraoperative complications have been reported to the main group. In the postoperative period, seroma occurred in 5.2% of cases, infiltrate in 2.63%, and postoperative wound suppuration in 2.63%. The mortality in this group was observed in one case (1.19%).

Conclusion: The use of laser therapy through cholecystostomy during bile duct decompression helps reduce the incidence of intra- and postoperative complications, improves the results of surgical treatment and the quality of life of patients.

Keywords: Cholecystectomy, cholecystostomy, two-stage tactics , laser therapy, «high risk» patients.

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Authors' information:

Abdullozoda Dzhamoliddin Abdullo
Doctor of Medical Sciences, Professor of the Department of General Surgery № 2, Avicenna Tajik State Medical University; Director of the Istiklol Health Complex
ORCID ID: 0000-0002-8509-4231
Author ID: 960954
SPIN: 9268-0866
E-mail: Abdullozoda-Jamoliddin@mail.ru

Gulomov Loik Abdurakhmonovich
Applicant of the Department of General Surgery № 2, Avicenna Tajik State Medical University
ORCID ID: 0000-0002-0276-3787
SPIN: 1263-1295
E-mail: loiqmed@gmail.com

Safarzoda Abdullo Mumin
Doctor of Medical Sciences, Associate Professor, Assistant of the Department of General Surgery № 1, Avicenna Tajik State Medical University
ORCID ID: 0000-0002-6269-4322
Author ID: 1058183
SPIN: 5875-3276
E-mail: Safarzoda-Abdullo@list.ru

Information about support in the form of grants, equipment, medications

The authors did not receive financial support from manufacturers of medicines and medical equipment

Conflicts of interest: No conflict

Address for correspondence:

Gulomov Loik Abdurakhmonovich
Applicant of the Department of General Surgery № 2, Avicenna Tajik State Medical University

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

Tel.: +992 (907) 953565

E-mail: loiqmed@gmail.com

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