Simultaneous hybrid surgeries in performing laparoscopic cholecystectomies

Background. Simultaneous surgical interventions during laparoscopic cholecystectomy account for 0.5–16% of the total number of operations. Minimally invasive laparoscopic technologies and traditional open surgery are creatively combined in hybrid laparoscopic methods. By integrating minimally invasive techniques with conventional open surgery concepts, hybrid laparoscopic methods aim to maximize the advantages of each. Purpose – study of the effectiveness of simultaneous operations using hybrid technologies in cases of gallstone disease combined with abdominal organ diseases. Materials and Methods. The study analyzed the treatment results of 243 patients who underwent hybrid simultaneous surgeries for combined abdominal diseases with gallstone disease, which accounted for 2.2% of all laparoscopic cholecystectomies. Indications for simultaneous surgeries included anterior abdominal wall hernias (211 patients), uterine fibroids (24 patients), and hematologic spleen diseases (8 patients). All hybrid simultaneous surgeries were pre-planned. Results. It was found that fully laparoscopic simultaneous operations are not advisable for cases combining gallstone disease with umbilical hernias, midline abdominal hernias, and medium to large ventral postoperative hernias. In such cases, the preferred surgical option is a hybrid simultaneous operation (laparoscopic cholecystectomy and open hernioplasty). In patients with a spleen size exceeding 20 cm in the craniocaudal direction, the first stage involved laparoscopic cholecystectomy, followed by open splenectomy. Performing laparoscopic splenectomy in these patients was deemed inappropriate due to technical difficulties and the loss of minimally invasive advantages. Conclusions. When gallstone disease is combined with umbilical hernias, midline abdominal hernias, and medium to large ventral postoperative hernias, the surgery of choice is a hybrid simultaneous operation (laparoscopic cholecystectomy and open hernioplasty). Performing hybrid simultaneous operations (laparoscopic cholecystectomy and laparoscopic-assisted transvaginal hysterectomy) allows for the preservation of the integrity of the anterior abdominal wall while enabling reconstructive muscle tissue plastic surgery if necessary. This approach has high efficiency and significant medical-social benefits. In cases of significant splenomegaly, laparoscopic access becomes inappropriate, and a hybrid simultaneous operation (laparoscopic cholecystectomy and open splenectomy) is recommended for gallstone disease combined with hematologic spleen diseases.