Targeted ultrasound examination of the edges of the abdominal cavity in patients with gallstones and concomitant bile duct diseases as a method of preventing intraoperative complications during laparoscopic cholecystectomy

Background. Statistical data from the last three decades indicate that gallstone disease (GSD) occupies a dominant position among all gastroenterological pathologies requiring surgical intervention. Despite the widespread implementation of modern minimally invasive surgical techniques, the increase in the number of operations for this condition has been accompanied by a rise in intra- and postoperative complications and unsatisfactory treatment outcomes. Patients with a history of previous abdominal surgeries, leading to the development of adhesions, are at higher risk of persistent pain syndrome, abdominal discomfort, and intra- and postoperative complications. This necessitates a very cautious approach to the initiation, execution, and conclusion of laparoscopic cholecystectomy. The current protocol for instrumental diagnosis of adhesion disease and especially adhesive bowel obstruction includes: abdominal ultrasound (US), plain and contrastenhanced radiography of the abdomen, and computed tomography (CT) and magnetic resonance imaging (MRI), respectively. The development and implementation of an accessible program addressing these issues based on evidence-based medicine principles will improve treatment outcomes for this patient group. Purpose. The objective of this study is to investigate and substantiate the necessity of targeted abdominal ultrasound in the preoperative period as an effective method for visualizing adhesive processes and preventing intraoperative and postoperative complications in patients with concurrent intra-abdominal adhesions (IAA). Materials and мethods. This study presents An analysis of surgical treatment outcomes was conducted for 11.549 patients with various forms of gallstone disease (GSD). Among these, 2.736 patients with a history of previous abdominal surgeries underwent LC along with various simultaneous procedures, accounting for 23.69% of all LCs performed. The cohort included 2.209 women and 527 men, with ages ranging from 16 to 78 years. Among the 2.736 patients with a history of abdominal surgeries, only 343 (12.54%) were diagnosed with intra-abdominal adhesions (IAA) during preoperative evaluation, necessitating simultaneous adhesiolysis. In 172 (6.29%) patients, IAA was definitively diagnosed intraoperatively (with high sonographic probability of adhesions preoperatively), and adhesiolysis was required to facilitate port placement, adequate revision, and visualization necessary for performing LC. Overall, adhesiolysis was performed in 515 (18.83%) patients. Preoperative Diagnostic Program: The preoperative diagnostic program included clinical and biochemical tests of blood and urine, electrocardiography (ECG), chest and abdominal radiography or fluoroscopy with and without contrast as indicated, targeted abdominal ultrasound (US) following a developed methodology, and, as needed, computed tomography (CT) and magnetic resonance imaging (MRI) of the abdomen. Abdominal ultrasound was performed using Sonoace 4800 devices from Medison, Toshiba Nemio, and Philips HDI 4000 in real-time mode. Linear, sector, and convex transducers with frequencies ranging from 2 to 5 MHz, as well as Doppler and energy transducers, were employed. Surgical Procedure: Laparoscopic cholecystectomy (LC) was carried out using standard techniques. During adhesion lysis, scissors, bipolar coagulation, and ultrasonic dissection/coagulation were used.