FEATURES OF LAPAROSCOPIC CHOLECYSTECTOMY FOR ACUTE CHOLECYSTITIS IN PATIENTS AFTER PREVIOUS SURGERIES ON ABDOMINAL CAVITY
DOI:
https://doi.org/10.11603/2414-4533.2026.1.15888Keywords:
laparoscopic cholecystectomy, adhesions, previous abdominal surgeriesAbstract
The aim of the work: to study the impact of adhesion process after previous open surgical interventions on the abdominal organs on the possibility of performing laparoscopic cholecystectomy.
Materials and Methods. The results of treatment of 685 patients with uncomplicated acute cholecystitis for the period 2021–2024 were retrospectively analyzed. According to the purpose of the study, patients were divided into three groups: the first group included patients without previous abdominal surgery (528 (77.0 %)), the second – patients with previous lower abdominal surgery (99 (14.5 %)), the third – patients with previous upper abdominal surgery performed through a midline incision (58 (8.5 %)). That is, 157 (23.0 %) patients from the total number of patients had previous open abdominal surgery.
Results and Discussion. Previous abdominal interventions are not contraindications to laparoscopic cholecystectomy, although they require certain tactical approaches to the surgical technique. No patient from the first and second groups required conversion to open cholecystectomy, and in patients from the third group, conversion was not associated with abdominal adhesions. Also, the operated patients did not have any complications during the placement of ports and adhesiolysis. In patients with previous interventions in the upper abdominal cavity, the duration of laparoscopic cholecystectomy is prolonged, and technical difficulties arise more often during the separation of adhesions in the subhepatic space and during the dissection of the vesical pedicle (63.3 versus 32.8 % and 33.5 %, respectively (p<0.001)). Also, in this group of patients, the time for recovery of peristalsis in the postoperative period and the duration of inpatient treatment are increased.
Conclusions. Previous abdominal surgery is not a contraindication to laparoscopic cholecystectomy for acute cholecystitis, however, the surgical procedure has certain characteristics that depend on previous open abdominal surgery. Adhesiolysis should only be performed to ensure technical access and laparoscopic cholecystectomy, following the rules of critical view of safety (CVS). Simultaneous adhesiolysis should be performed only if there is a risk of further development of intestinal obstruction (cord-like vascularized fibrous adhesions have formed, which disrupt the passage through the intestine).
Received: 10.01.2026 | Revised: 26.01.2026 | Accepted: 23.02.2026
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