Difficulties in preoperative management of patients with complicated gallstone disease on the background of liver cirrhosis
DOI:
https://doi.org/10.11603/2414-4533.2020.1.10749Keywords:
gallstone disease, liver cirrhosisAbstract
The aim of the work: to determine the main causes of the complexity of the organization of the preoperative period and the diagnosis of liver cirrhosis before surgery.
Materials and Methods. In retrospect, 77 patient histories were analyzed. The criteria for selecting patients for this study were the presence of complicated forms of gallstone disease (acute calculous cholecystitis, choledocholithiasis with obstructive jaundice, Mirizzi syndrome) and the presence of cirrhosis. Depending on the period of diagnosis of cirrhosis, all patients were conventionally divided into 2 groups: group 1 – patients with diagnosed liver cirrhosis of the preoperative stage (62), and group 2 – patients whose cirrhosis was verified intraoperatively (15). All patients in the preoperative period were examined according to the diagnostic protocols for the treatment of patients with complicated forms of cholelithiasis. The stage of cirrhosis was evaluated using the Child-Turcotte-Pugh system and the MELD scale. Among concomitant pathologies, prevailing chronic ischemic mesenteric disease prevailed (group 1 – 41, group 2 – 4), hypertension (group 1 – 15 group 2 – 2), diabetes mellitus (group 1 – 1 and group 2 – 3), obesity (group 1 – 2 and group 2 – 4).
Results and Discussion. According to the results of the study in group 2, a greater percentage of postoperative complications was observed, directly associated with intraoperative diagnosis of liver cirrhosis and the lack of a thorough assessment of the risks of the operation. Diagnosis of cirrhosis of the liver at the preoperative stage in many cases allows a more adequate assessment of the risks of surgical interventions, and appropriate therapy has been previously prescribed significantly reduces the risk of postoperative complications. The most “dangerous” from the point of view of not diagnosing liver cirrhosis at the preoperative stage is the combination of liver cirrhosis with obesity, diabetes mellitus and the presence of postoperative adhesions in the abdominal cavity. In the preoperative period, more attention should be paid to non-invasive diagnostic methods that can help suspect liver cirrhosis, even in the absence of data on portal hypertension; among them is the deRitis and FibroTest index.
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