Laparoscopic cholecystectomy in patients with acute cholecystitis require high professional degree of surgical team, improvement of a surgical technigue and preoperative examination.
The purpose of this study was to improve the results of surgical treatment in patients with acute cholecystitis by improvement of preoperative diagnosis and surgical technigue.
Materials and methods. The results of laparoscopic cholecystectomy in 472 patients with acute cholecystitis in age from 18 till 76 years old were analysed. The duration of a gallstone disease was from3 to 25 years. Multidetectional computed tomography by use of Toshiba Aqullion 16 in 9 patients was done.
Results and discussion. Multidetectional computed tomography give an exact information about hepatoduodenal zone abnormalities. In 1 patient cholelythiasis couldn’t be cured by endoscopy required classical cholecystectomy, in 6 patients — asymptomatic cholelythiasis was diagnosed, cured by endoscopy, in 1 patient III degree Mirizzi’s syndrome was diagnosed, cured by classical cholecystectomy.
Laparoscopic cholecystectomy in patients with acute cholecystitis is done at presence of tissue edema, adhesive process. Because of the fact that during 30 minutes the Callot triangle structures was impossible to identify, in 12 (2.5%) patiens — the subcostal lapatotomy was done, in 3 (0.6%) patients — medial laparotomy. In 11 (2.3%) patients the incision of anterior gallbladder wall was done with latter clamping of Callot triangle structures.
Laparoscopic cholecystectomy was finished by draining of supra- and subhepatic spaces by active tubular drainages. Intra- and postoperative complications were absent.
Conclusion. Multidetectional computed tomography gives an exact information about hepatoduodenal zone abnormalities. Subcostal laparotomy or medial laparotomy should be used in cases when Callot triangle structures are impossible to identify. The incision of anterior gallbladder wall was done with latter clamping of Callot triangle structures. Laparoscopic cholecystectomy should be finished by draining of supra- and subhepatic spaces by active tubular drainages.