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Procedure of surgery treatment method choice in patients with acute cholecystitis with high anesthetic risk

Written by Velichko E.A., Nekrasov A.Yu., Istomin N.P., Sergeev A.V.

  UDK: 616.366-002-036.11-089-072.1 | Pages: 26–29 | Full text PDF | Open PDF 

Annotation:

Background. Research objective is efficiency assessment of laparoscopic cholecystectomy (LCE) with fan-shaped laparolift and sustainable development of the algorithm of surgical treatment of acute calculous cholecystitis in patients with increased anesthetic risk.
Methods. The results of treatment of 154 patients aged 43–87 with acute cholecystitis were summarized. In 78 cases the LCE was carried out in gas-free environment using laparolifta own design (the study group), 76 cases of LCE performed under carboxyperitoneum at a pressure of 6–8 mm/Hg. For objectification of assessing the severity of the general condition used SAPS II – Simplified Acute Physiology Score.
Results. The median SAPS II in the study group was 31.9±1.6, the control – 29.8±1.4 points. The estimated risk of death in patients of the study group amounted to 9.5±0.6 %, which was 0.9 % less than in control group. The number of post-surgery complications when using fan-shaped laparolift was 27.3 % lower. In the control group mortality was 6.6 % (5 patients) in the group where LCE was performed with the use of fan-shaped laparolift, one person died (fatality rate 1.3 %).
Conclusions. Determining the severity of the general condition of SAPS II with the calculation of the prognostic index of hospital mortality at admission helps to choose the most rational method of surgery treatment of acute destructive cholecystitis in patients with increased anesthetic risk.

Links to authors:

E.A. Velichko1, A.Yu. Nekrasov1, N.P. Istomin1, A.V. Sergeev2
1 Federal Clinical Center of High Medical Technologies FMBA of Russia (Khimki, Novogorsk 143435 Russian Federation),
2 Clinical Hospital of Emergency Medical Services (9 Tenishevoi St. Smolensk 214000 Russian Federation)


1. Zubritskiy V.F. Surgical treatment of complicated forms of cholelithiasis in elderly people // Scientific works of State Institute of Physicians Training of Ministry of Defense of the Russian Federation. 2008. Vol. 1. P. 56–59.
2. Karimov Sh.I., Kim V.L., Khakimov M.Sh. The choice of surgical treatment of acute cholecystitis in patients with an increased surgical risk // Annals of Surgical Hepatology. 2004. Vol. 9, No. 1. P. 115–119.
3. Kasumyan S.A., Makurov A.A., Abramenkova I.V., Solovyev V.I. Invention Patent No. 2372045 МПК8 А61 В19/00, А61 В17/02. Fan-shaped Laparolift. 2008116916; Appl. 04.28.2008,11.10.2009.
4. Kuzin N.M., Dadvani S.S. Laparoscopic and conventional cholecystectomy: a comparison of the immediate results // Surgery. 2000. No. 2. P. 25–27.
5. Malyarchuk V.I., Rusanov V.P., Ivanov V.A., Malyuga V.Yu. Surgery of calculous cholecystitis in gerontological practice // Clinical Gerontology. 2004. Vol. 10, No. 2. P. 22–28.
6. Nazarenko P.M., Lyubitskiy A.A. Trocars as laparolifts in laparoscopic operations // Endoscopic Surgery. 2004. No. 1. P. 115.
7. Puchkov K.V. Influence of carboxyperitoneum on hemodynamics in patients at risk // Endoscopic Surgery. 2003. Appx. P. 108–109.
8. Tezyaev V.V. The possibility of using the mini-laparotomic cholecystectomy in acute cholecystitis in patients of middle and old age // Nizhegorodskiy Medical Journal. 2005. No. 2. P. 124–128.
9. Ustinov O.G., Zakhmatov Yu.M. Assessment criteria of endoscopic accesses // Endoscopic Surgery. 2003. No. 1. P. 39.
10. Shulutko A.M., Agadzhanov V.G. «Open» laparoscopy: ways to improve the surgical treatment of calculous cholecystitis in elderly patients // Clinical Gerontology. 2004. Vol. 10, No. 2. P. 39–42.
11. Chiu A.W., Chang L.S., Birkett D.H., Babayan R.K. The impact of pneumoperitoneum, pneumoretroperitoneum, and gasless laparoscopy on the systemic and renal hemodynamics // J. Am. Coll. Surg. 1995. Vol. 181. P. 397–406.
12. Ishizaki Y., Miwa K., Yoshimoto J. Conversion of elective laparoscopic cholecystectomy to open cholecystectomy between 1993 and 2004 // Br. J. Surg. 2006. Vol. 93. P. 987–991.
13. Korolija D., Sauerland S., Wood-Dauphinée S. Evaluation of quality of life after laparoscopic surgery. Evidence-based guidelines of the European Association for Endoscopic Surgery // Surg. Endoscopy. 2004. Vol. 18. P. 879–897.
14. Le Gall J.Р., Lemeshow S., Saulnier F. A new simplified acute Physiology Score (SAPS II) based on a European // JAMA. 1993. Vol. 270. P. 2957–2963.
15. Tambyraja A.L., Kumar S., Nixon S.J. Outcome of laparoscopic cholecystectomy in patients 80 years and older // World J. Surgery. 2004. Vol. 28. P. 151–156.

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