SPECIFICS OF PERFORMING LAPAROSCOPIC CHOLECYSTECTOMY IN PATIENTS WITH ACUTE CHOLECYSTITIS
DOI:
https://doi.org/10.11603/2414-4533.2025.2.15394Keywords:
Acute cholecystitis, technical features of laparoscopic cholecystectomy, prognosis of postoperative complicationsAbstract
The aim of the work: to examine the advantages of laparoscopic cholecystectomy (LCE) in patients with acute cholecystitis based on their constitutional body build, and to analyze the frequency of postoperative complications.
Materials and Methods. We investigated the features and benefits of performing laparoscopic cholecystectomy in 215 patients with acute cholecystitis of various constitutional types; women constituted the majority (72 %). Constitutional body types were assessed using anthropometric methods. The study was conducted using an Aesculap Flow 40 insufflator, delivering CO2 at a pressure of 0.6 MPa. Video port placement followed generally accepted methodology. Pneumoperitoneum was initially established at 5 mmHg, with subsequent gradual increases until a sufficient level was achieved. CO2 pressure was recorded in a logbook for calculating average statistical values. Statistical analysis included univariate and multivariate analyses to identify factors associated with complicated laparoscopic cholecystectomy, and odds ratios (ORs) and their 95 % confidence intervals were calculated. For statistical analysis, we used SAS software (SAS Institute, NC, USA).
Results. Minimum pneumoperitoneum levels for visualizing the surgical field during instrument port placement were developed based on the development of subcutaneous fat, along with the precise location and angle of video port insertion depending on body build. For a body mass index (BMI) of 19–25 kg/m2, the minimum pneumoperitoneum level was 6.9–10 mm Hg. For a BMI of 25–35 kg/m2, it was 7.4–10 mm Hg, and for a BMI of 35–40 kg/m2, it was 8.3–10 mm Hg. The frequency of postoperative complications after laparoscopic cholecystectomy in patients with different body types was analyzed. It was confirmed that a hypersthenic body build is the greatest risk factor for all investigated complications after laparoscopic cholecystectomy in patients with acute cholecystitis, specifically: the highest risk of trocar hernia (OR=6.91); a statistically significantly increased risk of wound infection (OR=3.89), infiltrate (OR=5.58), and seroma (OR=4.18); the overall risk of complications was 5.51 times higher compared to asthenic-normosthenic types.
Conclusions. The conducted analysis of postoperative complications associated with laparoscopic cholecystectomy allowed for the optimization of technical aspects of the operation in patients with acute cholecystitis, taking into account their constitutional body build.
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