Abstract

Objective

To establish reasonable indications, determine potential capabilities and identify technical features of using non-standard laparoscopic techniques for calculous cholecystitis.
 

Materials and Methods

The results of 94 laparoscopic cholecystectomies in patients with calculous cholecystitis performed by atypical methods were analyzed at the Clinic of Surgical Diseases No. 1 named after Academician K. M. Kurbonov, State Educational Institution “Tajik State Medical University named after Abuali ibn Sino” and State Institution “Institute of Gastroenterology of the Republic of Tajikistan”. Among them, there were 51 men (54.2%), 43 women (45.8%). The age of the patients ranged from 19 to 77 years. Laparoscopic cholecystectomy from the bottom was performed in 37 (39.4%) cases, subtotal laparoscopic cholecystectomy – in 33 (35.1%) – and in 19 (20.2%) patients, according to indications, the laparoscopic version of the Pribram operation was performed. In 3 (3.2%) cases, conversion was performed.
 

Results

During laparoscopic cholecystectomy, bile leakage from the gallbladder was noted in 14 (14.9%) cases. Mirizzi syndrome type I was established in 4 (4.2%) cases, where non-standard versions of laparoscopic cholecystectomy were performed. The methods of non-standard laparoscopic cholecystectomy developed and improved in the clinic, including scrupulous and thorough performance of the operation, allowed to exclude cases of iatrogenic injuries. In the postoperative period, moderate bile leakage from the gallbladder bed (50-100 ml) occurred in 4.2% of patients, which stopped on its own on the 2-3 day. Postoperative complications were noted in 8.5% of cases, in the form of suppuration of trocar wounds (n=1), bile leakage (n=2), thromboembolism of small branches of the pulmonary artery (n=1) and hypostatic pneumonia (n=4). There were no fatal cases. 
 

Conclusion

Non-standard laparoscopic cholecystectomies, according to indications, allow for high precision of surgical intervention and prevent possible life-threatening complications in complex topographic and anatomical conditions.
 

Keywords

calculous cholecystitis atypical gallbladder locations Mirizzi syndrome laparoscopic version of Pribram's operation subtotal laparoscopic cholecystectomy.

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