Conceptual Issues of Terminology and Term Selection for Surgery in Patients With Acute Obstructive Calculous Cholecystitis

The aim of the work: to develop modern terminology issues and the selection of terms for laparoscopic cholecystectomy based on the assessment of the stages of the inflammatory process, general clinical and local morphological criteria of acute obstructive calculous cholecystitis. Materials and Methods. Data of 408 patients with acute cholecystitis were analyzed. Patients were categorized into groups based on the duration of the disease: up to 3 days, 3–5 days, and 6–10 days from the onset of the first biliary colic episode. The staging of acute cholecystitis was assessed depending on the duration of cystic duct obstruction and comorbid pathology. Based on these findings, the optimal timing of laparoscopic cholecystectomy was proposed and confirmed by morphological studies of the removed gallbladders within the corresponding surgical timeframes as well as data from the correlation analysis of acute cholecystitis factors. Results. It was proven that profound hemodynamic disturbances and prolonged inflammation played a key role in the pathogenesis of remodeling structural components of the gallbladder. These findings justify the choice of early laparoscopic cholecystectomy (within 12–24 hours) after the diagnosis is established. Conclusions. The developed model of acute “surgical” cholecystitis based on acute obstructive calculous cholecystitis will significantly improve the outcomes of laparoscopic cholecystectomy at various postoperative periods.