[levdub]

А вот еще пару интересных ссылок о показанности симультантной ХЭ:

It was concluded that concomitant cholecystectomy added minimal morbidity to the operation and should be performed unless specific contraindications exist. Left untreated, the long-term risk that previously silent GSs would become symptomatic and cause complications, requiring operative intervention with greater morbidity, was substantial. Therefore, many authors now accept that incidental cholecystectomy is safe during gastrointestinal surgery and preoperative detection of GSs by ultrasonography is recommended in planning the incision and obtaining the patient's consent for cholecystectomy. ([Ссылки доступны только зарегистрированным пользователям ])

CONCLUSIONS: Incidental cholecystectomy was not associated with increased postoperative morbidity, whereas the long-term risk that previously asymptomatic gallstones would become symptomatic was substantial. Unless there are clear contraindications, patients with asymptomatic gallstones who have colorectal surgery should have concomitant cholecystectomy. ([Ссылки доступны только зарегистрированным пользователям ], 1994!)


CONCLUSIONS: These results suggest that unplanned incidental cholecystectomy for gallstones and cholecystitis during major abdominal surgery is justified if it is easily accessible and the condition of the patient warrants the additional procedure. (Kor J Gastroenterol 2000;35:349 - 355) ([Ссылки доступны только зарегистрированным пользователям ])

Incidental cholecystectomy: questionable for asymptomatic patients undergoing nonbiliary surgery; studies of effects on operative morbidity contradictory; risk for long-term complications in asymptomatic patients with gallstones, 1% to 20%, depending on study; in series of 195 patients who underwent incidental surgery (compared to 110 who did not), no difference in operative morbidity and mortality between groups; no-cholecystectomy patients followed for mean of 6 yr; 16 (14.5%) developed biliary complications; 5-yr cumulative probability of undergoing cholecystectomy, 21.6%; similar findings observed on longer (8 yr) follow-up, with cumulative probability of cholecystectomy >30%; also, slight risk of missing small gallbladder malignancy; conclusion—low-risk patients with asymptomatic gallstones should undergo concomitant cholecystectomy
http://www.cme-ce-summaries.com/general-surgery/gs5503.html

[Ссылки доступны только зарегистрированным пользователям ]