ANALYSIS OF THE POSTOPERATIVE PERIOD IN PATIENTS WHEN PERFORMING SUBTOTAL LAPAROSCOPIC CHOLECYSTECTOMIES
About the author:
Dudchenko M. O., Kravtsiv M. I., Adamsky M. O., Ivashchenko D. M., Prikhidko R. A.
CLINICAL AND EXPERIMENTAL MEDICINE
Type of article:
For many years, laparoscopic cholecystectomy has been the gold standard in the treatment of cholecystolithiasis. The key to safe execution of this operation, as well as open cholecystectomy, is the correct determination of the elements of the gallbladder neck. However, in some cases, especially in acute processes and anomalies of the development of the biliary system, the isolation of the anatomy of the Kahlo triangle causes considerable difficulties, or can be totally impossible. In this case, the conversion is considered a justifiable tactic. However, more and more studies name laparoscopic subtotal cholecystectomy as an effective alternative to open surgery. The aim of the study was to analyze the postoperative course in patients who had received laparoscopic subtotal cholecystectomy and laparoscopic total cholecystectomy and to determine the effect of the method of surgery on the quality of life of patients. In the study group, the average duration of the operation was 1.4 ± 0.4 hours. Intraoperative blood loss ranged from 50 to 120 ml (mainly diffuse, as a result of the separation of infiltrate). The period of observation of patients after discharge from the hospital was 1 year. Intra- and postoperative complications (early and late) were not detected. Duration of drainage of the subhepatic space 3 ± 1 day. The length of hospital stay was 6 ± 1 days. Pain persisted for about 3.0 ± 1 days. According to the data obtained, it can be concluded that laparoscopic subtotal cholecystectomy is indeed an effective alternative to the conversion in difficult cases of determining the anatomy of the gallbladder neck region. This procedure, although it somewhat prolongs the patient’s stay in the hospital, slightly prolongs the duration of the pain syndrome and intraoperative blood loss, however retains all the advantages of laparoscopic total cholecystectomy and can be recommended for performance. In the future, it is planned to expand the research group of patients, to analyze also laboratory and morphological parameters and to formulate clear criteria and indications for subtotal cholecystectomy.
subtotal cholecystectomy, laparoscopy.
- Griffiths E, Hodson J, Vohra R, Marriott P, Katbeh T, Zino S, et al. Correction to: Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy. Surgical Endoscopy. 2018;33(1):122-5.
- Elshaer M, Gravante G, Thomas K, Sorge R, Al-Hamali S, Ebdewi H. Subtotal Cholecystectomy for “Difficult Gall- bladders”. JAMA Surgery. 2015;150(2):159.
- Dudchenko MO. Likuvannia hostroho kalkuloznoho kholetsystytu: “rannia” chy “planova” laparoskopichna kholetsystektomiia? Klinichna khirurhiia. 2015;6:19-21. [in Ukrainian].
- Strasberg S, Pucci M, Brunt L, Deziel D. Subtotal Cholecystectomy–“Fenestrating” vs “Reconstituting” Subtypes and the Prevention of Bile Duct Injury: Definition of the Optimal Procedure in Difficult Operative Conditions. Journal of the American College of Surgeons. 2016;222(1):89-96.
- Abdelrahim W, Elsiddig K, Wahab A, Saad M, Saeed H, Khalil E. Subtotal laparoscopic cholecystectomy influences the rate of conversion in patients with difficult laparoscopic cholecystectomy: Case series. Annals of Medicine and Surgery. 2017;19:19-22.
Publication of the article:
«Bulletin of problems biology and medicine» Issue 2 Part 2 (151), 2019 year, 114-116 pages, index UDK 616.366-002-089