MINIMIZATION OF APPROACHES IN LAPAROSCOPIC CHOLECYSTECTOMY

Objective: the aim of the study was to estimate the influence of a number of endoscopic approaches on the effectiveness of laparoscopic cholecystectomy. Methods: retrospective analysis of case histories of 118 patients was applied for the purpose of comparative evaluation of the results of surgical treatment using a three- and four-port laparoscopic approach. Patients were divided into two groups: patients operated using three-port laparoscopic approach (n=60 patients) and patients operated using four-port approach (n=58 patients). One of the important stages of studies was histomorphological characterization of the removed gallbladder, which was performed in all 118 patients who underwent minimally invasive operations. Conventional visual analogue scale of pain (VAS) was used for the subjective assessment of pain syndrome manifestations. Results: 60 patients underwent three-port laparoscopic cholecystectomy (LC) (main group) and 58 patients underwent four-port LC (control group). In the main group, 53 (88.3%) patients showed the absence of any pain, only 3 of them reported mild pain, and 4 – moderate pain, respectively, on the 7th day after surgical intervention. In the control group, these parameters were 50 (86.2%), 2 and 6 subjects, respectively. Terms of hospitalization and disability were relatively lower at the minimal number of ports: 3.2 and 4.4 days, respectively. Disability duration in the main group was 8.5 days versus 10.6 days in the control group. Conclusion: three-port laparoscopic approach technique allows significantly reducing the rate of pain syndrome clinical manifestations, achieving maximal cosmetic effect, and considerably shortening postoperative rehabilitation period, thus resulting in earlier activation of patients and restoration of their working capacity.