Laparoscopic cholecystostomy in acute diseases of the extrahepatic biliary tract

Diagnosis and treatment of acute diseases of the extrahepatic biliary tract sometimes present significant difficulties, especially in elderly and senile people. This problem is also complicated by the fact that sometimes with inflammation of the gallbladder that does not respond to conservative therapy, it is difficult to decide on an emergency operation, especially in elderly and senile people with severe concomitant diseases, since their operational risk is too high. Surgical intervention is also extremely dangerous for patients with long-term mechanical jaundice, since in the postoperative period they may have progression of existing liver failure. In such cases, laparoscopic cholecystostomy is justified as a therapeutic method [2]. According to the method proposed by I. D. Prudkov (1974), it is necessary to remove the bottom of the gallbladder and attach it to the skin of the abdominal wall. However, with a sharply infiltrated and edematous wall of the gallbladder, as well as with its dense fusion with the edge of the liver, it is not possible to remove its bottom and fix it to the skin of the abdominal wall. All this significantly limits the possibilities of laparoscopic cholecystostomy using this technique. In such cases, transhepatic cholecystostomy is indicated [1, 3].