Differentiated approach to the choice of surgical access for calculous cholecystitis
The aim of the research is evaluating the effectiveness of applying differentiated approach to the choice of surgical access for calculous cholecystitis and determining additional criteria that could complement the existing algorithm. Material and methods. The study consisted of 3 stages. At the first stage, based on retrospective analysis of case histories of patients with calculous cholecystitis, a differentiated approach to the choice of surgical access was developed and put into practice in our clinic. At the second stage, we evaluated the application of this algorithm. At the third stage, on the basis of prospective analysis, the possibility of using alkaline phosphatase and gamma-glutamyltransferase activity in the blood of patients with calculous cholecystitis at preoperative stage was assessed as an additional criterion in comprehensive assessment of the severity of inflammatory process in the gallbladder wall and perivesical space. Results. The criteria chosen by us for the algorithm of differentiated approach to the choice of operative access for calculous cholecystitis made it possible to expand the indications for laparoscopic access when laparotomy was previously performed. But despite this, conversion is to be performed in technically difficult cases. The study has proved that activity of alkaline phosphatase and gamma-glutamyl transferase in blood mainly increases in acute cholecystitis. Conclusion Thus, the differentiated approach developed and used in our clinic has allowed to increase the number of laparoscopic cholecystectomies in acute calculous cholecystitis. At the same time, the number of conversions of laparoscopic access to laparotomy has almost doubled. According to the results obtained, determination of alkaline phosphatase and gamma-glutamyltransferase can be used as such criteria, but only in comprehensive diagnosis along with other indicators.