[Cholecystostomy in acute cholecystitis in modern surgical practice]. / Kholetsistostomiya pri ostrom kholetsistite.

OBJECTIVE: To improve the results of treatment of acute cholecystitis. MATERIAL AND METHODS: A historical cohort study (1965-2016) included 1248 patients with acute obstructive cholecystitis and 154 patients with acute obstructive cholecystitis combined with ductal complications and obstructive jaundice. Cholecystostomy was used in all patients. A systematic review of the evidence base on the use of cholecystostomy in high-risk patients was carried out. RESULTS: Cholecystostomy through laparotomy was performed in 240 patients for the period 1965-1981. Overall mortality was 3.6%. Staged treatment strategy has been applied since 1982. Laparoscopic cholecystostomy followed by cholecystectomy through laparotomy was performed in 225 patients for the period from 1982 to 1992. Overall mortality rate was 3.2%. Laparoscopic cholecystostomy (n=617) followed by staged laparoscopic cholecystectomy has been applied for the period from 1993 to 2007. Overall mortality decreased up to 1.1%. Indications for laparoscopic cholecystostomy and staged treatment have been limited since 2008 (n=166). Overall mortality rate was 0.6%. The maximum postoperative mortality after cholecystostomy in some years reached 14.8%.Simultaneous surgeries through laparotomy in patients with acute obstructive cholecystitis and ductal complications were followed by mortality rate 8%, staged laparoscopic cholecystostomy and other minimally invasive technologies (endoscopic papillosphincterotomy with lithoextraction and laparoscopic cholecystectomy) - 4.7%. CONCLUSION: External drainage of the gallbladder is more effective as additional method within staged minimally invasive treatment of complicated cholecystitis rather separate operation. Further analysis of treatment of high-risk patients with acute cholecystitis (as most often selected for cholecystostomy) is required considering the absence of evidence base on this issue.

[The comparative analysis of laparoscopic and minilaparotomic techniques in emergency abdominal surgery].

Owing the experience of 16 101 miniinvasive operations by acute diseases of the abdominal cavity, the authors pose that the introduction of polytechnological methods has certain perspectives. The combination of different methods with the use of modern technologies lead to better results.

[Contact dissolution of gallstones]. / Kontaktnoe rastvorenie kamnei zhelchnogo puzyria.

The techniques and results of contact dissolution of stones in the gallbladder of 27 patients subjected to laparoscopic cholecystostomy for acute cholecystitis were analysed. It was found that the main factors impeding effective dissolution were: the size of the stones over 1.5 cm and admixture of pigment in the concrements. The first Soviet produced litholytic preparation Oktalgin, synthesized by the authors jointly with the Zelinsky IOCh, AMS USSR, was used as the main solvent. The principal possibility of dissolving multiple stones of the gallbladder through laparoscopic cholecystostomy is proved.

[Therapeutic tactics after laparoscopic cholecystostomy in patients with acute cholecystitis]. / Lechebnaia taktika posle laparoskopicheskoi kholetsistostomii u bol'nykh s ostrym kholetsistitom.

Laparoscopic cholecystostomy was undertaken in 178 elderly and old-aged patients with acute cholecystitis. Dynamic cholecystoscopy with biopsy of the cystic mucosa and bacteriologic study of the bile was conducted for objective appraisal of the inflammatory process in the gallbladder. Concluding operations on the bile tract were carried out in 147 patients. New methods were applied in 10 patients: filling of the gallbladder and contact solution of the stones in the gallbladder and bile ducts.

[Dissolution of residual biliary calculi in early postoperative periods]. / Rastvorenie rezidual'nykh kamnei zhelchnykh protokov v rannie sroki posle operatsii.

The agent Octaglin was used for dissolving residual stones found in 5 patients in the early periods after operations on the biliary tract. It was administered through a drain left in the choledochus or cystic duct during the surgical intervention. The composition of the concrements was determined from examination of the biliary crystal structures by the method of polarizing light microscopy. The stones were dissolved completely in all cases so that 4 of the 5 patients did not need to be operated on for a second time.