EXPERIENCE OF THE USE OF POLYMER CLIPS FOR CLIPPING OF ELEMENTS OF THE CELL OF THE GOLD BUBBLE IN LAPAROSCOPIC CHOLECYSTECTOMY IN PATIENTS WITH ACUTE CALCULUS CHOLECYSTITIS ON THE BACKGROUND OF CHRONIC VIRAL LESIONS OF THE LIVER

The implementation of laparoscopic cholecystectomy (LHE) is a safe and effective treatment in patients with acute calculouscholecystitis (АKH) in the background of chronic diffuse liver disease. The literature data indicate that the conversion rate of LXE in GCS in patients with cirrhosis of the liver and hepatitis in open cholecystectomy is an average of 3.6-7% and does not exceed 12%. As clinical studies show, with LXE compared with open cholecystectomy, not only the reduction of the time of surgical intervention and the length of stay of the patient in the hospital, but also the reduction of intraoperative blood loss is noted. These data are important because the main complications of LXE are mainly bleeding, bile, wound infection, damage to extrahepatic bile duct, progression of portal hypertension with ascites development, peritonitis. These statistics indicate that the level of postoperative lethality in patients with GCS and chronic liver disease can reach 11.6%, while the use of LXE doubles the risk of complications. In foreign and domestic literature it is reported that the treatment of the duct of the gall bladder and the bladder artery are among the main and most important stages of laparoscopic surgery of the GC, especially in patients with concomitant pathology. Specialists note that it is precisely the treatment and clumping of the elements of the neck of the gallbladder is given a great deal of attention to patients with GCP with LXE. Traditionally, metal clips of various sizes and modifications are used during LXE. It should be noted that since the first LXE in France in the late 80's, the production and modification of metal clips is constantly being improved. However, their use is associated with a high risk of a variety of intraoperative technical problems, which leads to the need for additional clapping, conversion to open laparotomy , which not only increases the duration of surgical intervention, but also worsens the course of the postoperative period. In particular, metal clips can migrate during surgical intervention with the development of damage to important anatomical structures and the emergence of complications. It should be emphasized separately that the use of metal clips restricts the performance of some studies, especially magnetic resonance tomography, in the postoperative period, which is important in patients with chronic diffuse liver disease. Particular attention in patients with GCP in LXE is given to the reliability of clipping of the elements of the neck of the gallbladder, therefore, surgeons increasingly use polymer clips of the Hem-o-lock type, which are an alternative to metal clips. Due to its structure, the voltage at their closing is distributed over the entire area of the bouncing structure. An important advantage of this system is the lack of the ability to migrate the clip after its closure and precise control over its clo-sure. Hem-o-lock clips are closed smoothly and have the lowest risk of breaking the integrity of the clip-like structures. Currently, the use of a clip of this type is important and crucial in lapa-roscopic abdominal surgery. However, indications and contraindications for their use have not been finally established and publications in available national literature have not been found.Optimization of the technique of LHE in patients with GKH against the background of chronic viral hepatitis through the use of polymer clips at the stage of clumping elements of the cervix of the gall bladder.