Tactical and technical aspects of complex treatment of patients with acute destructive cholecystitis complicated with peritonitis and billary sepsis

Purpose of the study. To clarify the clinical anddiagnostic criteria of BS, caused by complicatedacute destructive cholecystitis for the developmentof optimal treatment tactics.Material and methods. 193 patients with acutedestructive cholecystitis and choledocholithiasis,complicated by peritonitis, had surgery on the basisof Odessa regional clinical center in the clinic ofsurgery № 2. All patients with BS were dividedinto two groups. In the first group, 115 non-invasivelaparoscopic surgical interventions were performed.In the second group, 78 patients were performedlaparotomy, cholecystectomy, choledochotomy andexternal drainage of choledoch duct, as well asexternal drainage of CAL.Results. In patients with BS and obstructivejaundice, prior emphasis was placed on activesurgical tactics, the use of noninvasive technologiesin combination with intensive infusion andantibiotic therapy. Of great importance in thetreatment of BS was also given to hemodynamic andrespiratory support, detoxification with the use ofefferent methods (hemosorption, plasmapheresis),rational antibiotic therapy, immunocorrection,antioxidants, and vitamin therapy.Conclusions. Adequately initiated treatmentwith the use of modern methods of diagnosis andconservative therapy, surgical interventions in theearly stages, reduces the percentage of developmentof severe complications and the number of fatalcases in this pathology. In perspective, it is necessaryto determine more precise markers of biliary sepsisat an early stage, to improve methods of endoscopic surgery and detoxification treatment.Keywords: acute destructive cholecystitis,biliary sepsis, cholangiogenic abscess of the liver.