Surgical Intervention for Biliary Peritonitis, Which Developed as a Complication Of Acute Destructive Cholecystitis

Abstract

Biliary peritonitis as a complication of acute destructive cholecystitis accounted for 7.1% and most often (35.2%) developed in elderly patients. According to the mechanism of development, 67.1% had perspiring biliary peritonitis with no pathognomonic signs of catastrophe in the abdominal cavity. Optimization of the tactical and technical aspects of surgical treatment of patients with biliary peritonitis using puncture diapeutics, laparoscopy, and transduodenal endoscopic interventions improved the results of treatment in the main study group, where complications in the immediate postoperative period accounted for 16.3% and mortality 4.1% (in the comparison group-33.3% and 6.1%, respectively).

Biliary peritonitis is one of the most severe and prognostically unfavorable diseases of the abdominal cavity [1, 5]. The incidence of biliary peritonitis only in acute calculous cholecystitis, according to the authors, ranges from 2.2 to 8.4 % [3,6,9]. Postoperative mortality ranges from 17.4 to 28% [4.11]. The main problem of biliary peritonitis is associated with a latent course at the initial stages of its development and late diagnosis. This makes it necessary to study the causes, improve diagnostic methods and surgical treatment of patients with this pathology. Based on the causes of bile leakage into the abdominal cavity, biliary peritonitis can be divided into perforated and perspiring, destruction and perforation of the gallbladder wall in the first case and perspiration in the second [5,7]. The frequency of relaparotomies after operations ranges from 5.6 to 17 %, and the most common cause of relaparotomies after these operations is ongoing and progressive biliary peritonitis [2,10].