Aim. To determine the ways to reduce postoperative morbidity and mortality in acute cholecystitis. Material and metods. Retrospective (2013–2014 years) and prospective non-randomized (2015–2016) analysis of outcomes in 804 patients with acute cholecystitis was performed. Analysis was carried out within two periods – before and after acceptance of national clinical recommendations “Acute cholecystitis” (2015). Protocols of diagnosis and treatment developed by our clinic were applied in the first period (2013–2014). 220 patients (group I) underwent surgery in the first period, 290 (group II) – in the second period. Results. There was significantly reduced incidence of conversions for laparoscopic and minimally invasive cholecystectomy from 4.09% to 2.41% (p < 0.05) (OR – 1.724; 95% CI 0.632–4.705). Incidence of extrahepatic bile ducts lesion, postoperative thrombotic, thromboembolic complications, cardiovascular complications (including myocardial infarction) were similar in both groups (p > 0.05) (for cardiovascular complications OR – 0.758, 95% CI 0.047–12.183). There was reduced length of hospital-stay from 11.5 ± 0.8 to 9 ± 0.5 days (p < 0.05). Slight augmentation of postoperative mortality in the second period (from 0.45% to 1.37%) was observed (p < 0.05) (OR – 3.063, 95% CI 0.340–27.599). Conclusion. Reduced number of conversions was predominantly caused by cholecystectomy in patients with milder gallbladder inflammation. It is explained by earlier surgery (within 24–48 h) when severe infiltration of surrounding tissues is absent. Preoperative prolonged medication (3–5 days) aggravates these processes, creates significant intraoperative technical difficulties and increases incidence of conversions.
Critically ill patients with acute cholecystitis are at increased risk for extensive gallbladder inflammation
