Журнал «Медицина неотложных состояний» Том 20, №8, 2024

Лапароскопічна холецистектомія на сьогодні є однією з найчастіше виконуваних операцій. З огляду на широке впровадження цієї процедури хірургами всіх рівнів кваліфікації, від новачків до експертів, стає вкрай важливою розробка набору рекомендацій, щоб підвищити її безпеку для пацієнтів. Оскільки в кожного хворого своя складність операції, починаючи від простих і закінчуючи складними випадками, пов’язаними з трикутником Calot, надзвичайно важливо підходити до лапароскопічного втручання ретельно, щоб запобігти будь-якій потенційній шкоді. З огляду на глобальну поширеність навіть рівень ускладнень 0,1% означає значну цифру. Тому настійно рекомендується практикувати безпечну холецистектомію. У цьому огляді наводяться сучасні підходи до виконання лапароскопічної холецистектомії в складних випадках — операції порятунку, щоб запобігти ушкодженню жовчних шляхів і судин. Зокрема, розглядаються особливості проведення субтотальної холецистектомії, холецистектомії від дна, інфундибулярної дисекції.

Laparoscopic cholecystectomy is one of the most frequent surgeries today. Given the procedure’s extensive adoption by surgeons across all skill levels, from novices to experts, it becomes imperative to develop guidelines to ensure its safety for patients. Since complexity of surgeries differ in each person, ranging from simple to intricate cases involving a frozen Calot’s triangle, it is extremely important to perform laparoscopic surgery carefully to avert any potential harm. Given its global prevalence, even a 0.1 % complication rate translates to a significant figure. Therefore, practicing safe cholecystectomy is advocated strongly. This review presents modern approaches to laparoscopic cholecystectomy in difficult cases — bailout surgery — to prevent damage to the bile ducts and vessels. In particular, the features of subtotal cholecystectomy, fundus-first cholecystectomy, and infundibular dissection are considered.

лапароскопічна холецистектомія; стратегія порятунку; субтотальна холецистектомія; холецистектомія від дна

laparoscopic cholecystectomy; bailout strategy; subtotal cholecystectomy; fundus-first cholecystectomy

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