Destructive cholecystitis
In case of gangrene of the wall and dense infiltrate, the anatomy is “erased” - open access allows you to go from the bottom with constant control; if safe isolation is impossible, subtotal cholecystectomy is performed with suturing of the stump from the inside. The subhepatic space is sanitized and drained for 2–4 days, antibiotics are prescribed based on culture of the effusion. This approach prevents the main complication - damage to the ducts. Recovery is longer than laparoscopic (work in 3-4 weeks), but safety is a priority.
Indications
- contraindications to pneumoperitoneum (severe cardiopulmonary pathology);
- massive adhesive process of the upper floor after operations;
- complicated forms: dense infiltrate, Mirizzi syndrome, fistulas;
- conversion in case of technical difficulties of laparoscopy (planned insurance).
Open surgery location today
Laparoscopy is the method of choice, but open cholecystectomy remains a necessary tool: for infiltrates and fistulas, direct tissue control is safer; for contraindications to gas in the abdomen, it is the only option. Mini access (4–6 cm) with a ring retractor combines the reliability of an open technique with less trauma: shorter hospitalization and recovery. All options are completed with the histology of the bladder; A two-day hospital stay is included according to the price list for open surgery.
