COMPLEX LAPAROSCOPIC CHOLECYSTECTOMY: ASSESSMENT AND CLASSIFICATION OF SURGICAL COMPLICATIONS
DOI:
https://doi.org/10.11603/2414-4533.2025.1.15174Keywords:
laparoscopic cholecystectomy, risk factors, complicationsAbstract
The aim of the work: to assess intraoperative difficulties during laparoscopic cholecystectomy, to identify factors affecting the complexity.
Materials and Methods. The results of laparoscopic cholecystectomies in 457 patients aged 20 to 89 years with acute and chronic calculous cholecystitis were analyzed. The diagnosis of cholelithiasis was verified using the PHILIPS AFFINITI 30 ultrasound device. The sonographic criteria for acute obstructive calculous cholecystitis were reviewed and the main clinical and morphological groups were identified.
Results. The study used a modified classification of the complexity of laparoscopic cholecystectomy, which included five classes. We analyzed clinical and ultrasound factors that can be taken into account in the presurgical prediction of complex laparoscopic cholecystectomy. For each potential risk factor, the odds ratio (OR) with a 95 % confidence interval (CI) was calculated. Demographic, clinical, laboratory and instrumental parameters were taken into account. The results of the study showed a number of statistically significant predictors of complicated cholecystectomy. The most significant risk factors were the presence of acute cholecystitis (OR=3.05; 95 % CI: 2.26–4.11), gallbladder wall thickness >4 mm (OR=2.63; 95 % CI: 1.95–3.55), and previous upper abdominal surgery (OR=2.41; 95 % CI: 1.73–3.35). Multivariate analysis confirmed that these factors are independent predictors of complicated cholecystectomy, which can be used for preoperative risk stratification and optimization of surgical tactics.
Conclusions. Our results emphasize the importance of careful preoperative assessment of risk factors for predicting possible complications during complex laparoscopic cholecystectomy and choosing the optimal surgical strategy.
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