PROBLEMS OF TREATMENT OF ACUTE CHOLECYSTITIS AND POSSIBLE WAYS OF THEIR SOLUTION

The purpose and objective of this study was to identify problems in the treatment of patients with acute cholecystitis and to identify possible solutions. The results of treatment of 355 cases of acute cholecystitis were analyzed. Up to 72 hours from the onset of the disease, 172 (48.5%) were operated on, and 183 (51.5%) after 72 hours. The severity of acute cholecystitis was assessed by the classification of the Tokyo Grade (TG 2007, 2013). Tokyo Grade 1: 163 (45,9%) Tokyo Grade 2: 178 (50,1%) Tokyo Grade 3: 14 (3,9%) (Tokyo 2007, 2013). Complications after laparoscopic cholecystectomy occurred in 56 cases (23.1%), and there were 25 intraoperative complications (10.3%). The number of laparoscopic cholecystectomy conversions was 12 (5%). Inflammatory dense infiltrate in the area of the gall bladder neck was found in 48 (19.8%) cases. Complications after traditional cholecystectomy occurred in 33 (33.3%) cases, intraoperative - 26 (24.8%), dense infiltration in the neck of the gallbladder was recorded in 32 (30.5%) cases. Postoperative mortality was 10 cases (2.8%). It is concluded that the main problems in the treatment of acute cholecystitis are the age of the disease before surgery, and the number of postoperative complications. The direct relationship of postoperative complications with intraoperative and difficulties in isolating elements of the gall bladder neck is proved. There is no single approach to the treatment of complicated forms of acute cholecystitis. It is necessary to develop and more widely implement new methods of minimally invasive treatment of destructive forms of acute cholecystitis.

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