Acute cholecystitis. Results of multicenter research and ways to further improvement of surgical tactics

Aim. To analyze the results of treatment of patients in the general network of level 2 surgical hospitals for compliance with the main provisions of the Tokyo Guidelines (2007—2018) and the National Clinical Recommendations of the Russian Society of Surgeons “Acute cholecystitis” (2015).

Materials and methods. A database of the results of surgical treatment of 754 patients with acute cholecystitis at 8 hospitals that function as hospitals of the 2nd level in Moscow, Yekaterinburg, Volgograd and Kislovodsk was formed and analyzed. As additional criteria, the Cushieri scale and the Integral Complications Severity Index (ICSI) developed by the authors on the basis of the “Accordion” classification were used.

Results. Activation of surgical tactics up to 4—6 hours of observation and refusal to management clearly destructive and obstructive forms of acute cholecystitis of mild and moderate severity is an effective way to improve treatment results. The advantage of the combined use of 3 main methods of cholecystectomy in the general network of surgical hospitals has been proven. Early laparoscopic cholecystectomy turned out to be preferable, being undertaken in a timely manner and with a mild course of cholecystitis, as well as under favorable local conditions in a number of patients with a moderate course of the disease. The mini-access cholecystectomy is safer in anatomically more complex situations. The results of interventions performed from a wide laparotomy were the least favorable. An increase in the frequency of “difficult” cholecystectomies is shown 60 hours after the onset of the disease with mild cholecystitis and 36 hours after acute cholecystitis of moderate severity. With the modern level of technical equipment, it is advisable to perform intraoperative cholangiography in all patients with an average probability of cholangiolithiasis.

Conclusion. The most promising trends in the assistance of emergency surgical care to patients with acute cholecystitis are the activation of surgical tactics, the differentiated use of the entire spectrum of minimally invasive technologies by multidisciplinary teams working around the clock. Their implementation requires the enlargement of hospitals, appropriate material and technical re-equipment and training of personnel with the development of related professional skills. Small surgical hospitals with a limited list of modern surgical technologies need to create special treatment and diagnostic algorithms that can improve the results of their activities.

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