Russian Military Medical Academy ReportsRussian Military Medical Academy Reports2713-23152713-2323Eco-Vector4341310.17816/rmmar43413Research ArticleFORECASTING A “DIFFICULT” LAPAROSCOPIC CHOLECYSTECTOMYAbasovS. Y-AlievR. K-RomachenkoP. N-S.M. Kirov Military Medical Academy of the Ministry of Defense13122020391S17718128082020Copyright © 2020, Abasov S.Y., Aliev R.K., Romachenko P.N.2020At present, the problem of treating patients with cholelithiasis (cholelithiasis) is becoming increasingly important. This is due to the widespread prevalence of diseases of the biliary system, reaching more than 10% of the world's population, with the number of patients increasing annually [5]. Today, the laparoscopic cholecystectomy (LCE) is the gold standard in the treatment of cholelithiasis. Currently, over 700,000 LCEs are performed annually in the United States [13]. In Russia, this figure is about 170,000 operations per year. The advent of laparoscopic techniques in the treatment of cholelithiasis has led to new and poorly understood complications. The most dangerous and disabling complications of cholecystectomy were and remain bile duct injuries (RVP), which are found in 0.4-3.5% of laparoscopic cholecystectomies. Considering the annual amount of LCE produced in the Russian Federation and the frequency of RVP during their implementation, we can get the absolute amount of RVP that should be expected. This number is about 1700 RVP annually [8,9,10]. The presence in some cases of LCE of severe complications, conversions, and a wide scatter of operating time led practicing surgeons to think about identifying technically difficult or “difficult” LCE from the total number of such operations, as well as the need to establish risk factors for the development of complications of this group of interventions. The article presents a retrospective study of 1024 patients who underwent laparoscopic cholecystectomy for acute and chronic cholecystitis in 2012-2019. As a result of the study, factors were identified that significantly increased the complexity of laparoscopic cholecystectomy, among them: age older than 58.5 years, near-bubble infiltrate according to ultrasound, tension of the wall of the pancreas. Based on the logistic model, a nomogram was created to assess the risk of complex laparoscopic cholecystectomy, which allows choosing the rational treatment tactics in patients with gallstone disease to reduce the incidence of postoperative complications and mortality.“difficult” laparoscopic cholecystectomyprediction of the complexitygallstone disease«трудная» лапароскопическая холецистэктомияпрогнозирование сложностижелчнокаменная болезнь[1. Запорожан, В.Н. Видеоэндоскопические операции в хирургии и гинекологии / В.Н. Запорожан, В.В. Грубник, В.Ф. Саенко, М.Е. Нечи-тайло. - Киев, 2000. - С.304.][2. Корнеенков, А.А. Разработка скрининговой карты для прогнозирования клинического исхода в оториноларингологии / А.А. Корне-енков // Российская оториноларингология. - 2019. -Т.2 (99). - №18. - С.25-35.][3. Корнеенков, А.А. Создание номограмм для оценки риска неблагоприятная клинического исхода / А.А. Корнеенков, С.Г. Кузьмин, В.Б. Дергачев, Д.Н. Борисов // Вестник Российской Военно-медицинской академии. - 2019. - №2. - С.114-121.][4. Костырной, А.В. Лапароскопическая холецистэктомия - отдаленные результаты / А.В. Костырной, Э.Я. Керимов, А.В. Косенко, Э.Б. Усеинов, Э.Э. Керимов. - Симферополь, 2016.][5. Курбанов, Д.М. Осложнения лапароскопической холецистэктомии / Д.М. Курбанов, Д.И. Расулов, А.С. Ашуров // Новости хирургии. - 2014. - №3. - С.366-373.][6. Махмадов, Ф.И. Анализ непосредственных результатов «трудной» лапароскопической холецистэктомии / Ф.И. Махмадов, К.М. Кур-бонов, С.Р. Рафиков, Ф.Х. Кузратов, З.А. Азизов // Здравоохранение Таджикистана. - 2014. - С.32-39.][7. Михин, И.В. Лапароскопическая холецистэктомия у пациентов с избыточной массой тела / И.В. Михин, А.А. Воробьев, М.Б. Доронин, О.А. Косивцов, Л.А. Рясков. - Ростов-на-Дону, 2017.][8. Ревишвили, А.Ш. Состояние экстренной хирургической помощи в Российской Федерации / А.Ш. Ревишвили, А.В. Федоров, В.П. Сажин, В.Е. Оловянный // Хирургия. Журнал им. Н.И. Пирогова. - 2019. - №3. - С.88-97.][9. Ромащенко, П.Н. Особенности оказания хирургической помощи пострадавшим с травмой желчевыводящих путей в госпитальном звене / П.Н. Ромащенко, Н.А. Майстренко, А.С. Прядко, А.К. Алиев // Военно-медицинский журнал. - 2019. - Т.340. - №2. - С.27-35.][10. Ромащенко, П.Н. Травмы желчевыводящих протоков и системный подход к их устранению / П.Н. Ромащенко, Н.А. Майстренко, А.С. Прядко, А.К. Алиев // Анналы хирургической гепатологии. - 2019. - Т.14. - №1. - С.71-82.][11. Турбин, М.В. Опыт выполнения лапароскопической холецистэктомии при осложненных формах острого холецистита / М.В. Турбин, М.Ф. Черкасов, О.Л. Дягтерев, Ю.В. Красенков, В.А. Бондаренко. - Ростов-на-Дону, 2017.][12. Agarwal, N. Endoscopic management of postoperative bileleaks / N. Agarwal // Hepatobiliary Pancreat. Dis. Int. - 2006. - Vol.5. - №2. - P.273-277.][13. Bouarfa, L. Prediction of intraoperative complexity from preoperative patient data for laparoscopic cholecystectomy / L. Bouarfa, A. Schneider, H. Feussner, N. Navab, H.U. Lemke, P.P. Jonker, J. Dankelman // Artificial Intelligence in Medicine. - Delft, Munchen, Berlin, 2011. - Р.169-176.][14. de Mestral, C. Comparative operative outcomes of early and delayed cholecystectomy for acute cholecystitis: a population-based propensiry score analysis/ С. de Mestral, O.D. Rotstein, A. Laupacis, J.S. Hoch, B. Zagorski, A.S. Alali [et al.] // Ann. Surg. - 2014. - Р.259.][15. Ekici, U. Preoperative and postoperative risk factors in laparoscopic cholecystectomy converted to open surgery / U. Ekici, F. Tatli, M. Kanlioz // Advances in Clinical and Experimental Medicine. - 2019. - 28(7). - Р.857-860.][16. Ravindra, N. Predicting difficult laparoscopic cholecystectomy based on clinicoradiological assessment / N. Ravindra, V.U. Tejaswini, S. Prasad, B. Ramakantn, S. Vikram, N. Basavaraj // Journal of Clinical and Diagnostic Research. - 2015. - Р.9-12.][17. Rothman, J.P. Preoperative Risk Factors for Conversion of Laparoscopic Cholecystectomy to Open Surgery - A Systematic Review and Meta-Analysis of Observational Studies / J.P. Rothman, J. Burcharth, H.C. Pommergaard // Digestive Surgery. - 2016. - №33. - Р.414-423.][18. Sugrue, М. Grading operative findings at laparoscopic cholecystectomy - a new scoring system / M. Sugrue, Sh.M. Sahebally, L. Ansaloni, M.D. Zielinski // World Journal of Surgery. - 2015.][19. Veerank, N. Validation of a scoring system to predict difficult laparoscopic cholecystectomy: a one-year cross-sectional study / N. Veerank, M.D. Togale // J. West Afr. Coll Surg. - 2018. - №8(1). - Р. 23-39.]