Vo
lu
m
e
5,
Fe
br
ua
ry
,2
02
5
,
M
ED
IC
AL
SC
IE
N
CE
S.
IM
PA
CT
FA
CT
OR
:7
,8
9
DIAGNOSIS OF ACUTE DESTRUCTIVE CHOLECYSTITIS IN PATIENTS
UNDERGOING LAPAROSCOPIC SURGERY IN REGIONAL HOSPITALS
Yakubov F.R., Sapaev D.S., Matkurbonov N.O., Ismoilov A.O.
Urgench branch of Tashkent medical academy
Abstract:
Acute cholecystitis is one of the most common diseases of the abdominal cavity.
Materials and methods. The study material was the medical records of 77 patients operated
on in the Khankinsky district hospital in 2023 for acute cholecystitis within 72 hours of the
onset of the disease. Results and discussion. Our univariate analysis of variance allowed us
to establish that there is a significant difference in average values between the groups of
patients with catarrhal and destructive acute cholecystitis according to a number of studied
indicators, which allows them to be used as prognostic factors for the detection of acute
destructive cholecystitis. Conclusion. In order to timely resolve the issue of urgent
laparoscopic cholecystectomy in a regional hospital, the diagnosis of acute destructive
cholecystitis with a high degree of reliability can be established by identifying a
combination of clinical, ultrasound signs and changes in functional liver tests.
Keywords:
acute destructive cholecystitis; laparoscopic surgery; cholecystectomy;
functional liver tests.
Introduction.
Acute cholecystitis is one of the most common diseases of the abdominal
cavity. In the last two decades, significant progress has been made in the diagnosis and
improvement of its treatment methods, which has significantly reduced the rates of
postoperative complications and mortality in this pathology [1-6].
Cholecystectomy is a radical intervention leading to a complete recovery of the patient.
Laparoscopic cholecystectomy is one of the minimally invasive and effective surgical
interventions for acute destructive cholecystitis. Performing laparoscopic cholecystectomy at
an early stage makes it a relatively safe and affordable intervention, which provides an
additional advantage in the form of shorter hospital stays. To reduce the number of
conversions, laparoscopic cholecystectomy is most appropriate within 72-96 hours of the
onset of the attack [7-9]. However, early diagnosis of acute destructive cholecystitis often
causes difficulties, because the available clinical, laboratory and instrumental data do not
always allow us to exclude or confirm the presence of destructive changes in the gallbladder
wall. Accordingly, the purpose of our study was to study the effectiveness of the main
methods used in the diagnosis of acute cholecystitis in regional hospitals.
Materials and methods.
The study material was the medical records of 77 patients operated
on in the Khanka district hospital in 2023 for acute cholecystitis within 72 hours of the onset
of the disease. All patients were divided into two groups: the first group with acute
cholecystitis without signs of destruction – 35 people; the second with acute destructive
cholecystitis – in the presence of phlegmonous and gangrenous changes according to the
results of morphological examination of preparations of removed gallbladders - 42 people.
Medical history data, clinical examination results, general and biochemical blood tests, and
ultrasound examinations were used.
Vo
lu
m
e
5,
Fe
br
ua
ry
,2
02
5
,
M
ED
IC
AL
SC
IE
N
CE
S.
IM
PA
CT
FA
CT
OR
:7
,8
9
Patients with ASA III or IV surgical risk, over the age of 70, with a history of upper
abdominal surgery, and pregnant women were not included in the study. For quantitative
normally distributed features, statistical reliability was assessed using the Student's criterion
(t). Nonparametric criteria were used for a different distribution of features from the normal
one. The differences were considered significant with an error probability of P<0.05. One-
factor analysis of variance was used to identify the significance of the established prognostic
factors. To calculate the diagnostically significant levels, we used the definition of reference
intervals using a central range covering 95% of the data values [10]. The obtained research
results were processed using the STATISTICA 6.0 software package.
Results and discussion.
Our univariate analysis of variance allowed us to establish that
there is a significant difference in average values between the groups of patients with
catarrhal and destructive acute cholecystitis according to a number of studied indicators,
which allows them to be used as prognostic factors for the detection of acute destructive
cholecystitis. For each of the identified prognostic factors of acute destructive cholecystitis,
the following were calculated: the point of a diagnostically significant level (Cut-off point),
sensitivity (Se), specificity (Sp), the prognostic value of a positive (+PV) and negative result
(-PV), accuracy (diagnostic effectiveness). Traditionally, the diagnosis of acute destructive
cholecystitis is made on the basis of a set of data from clinical, laboratory and instrumental
research methods. The established prognostic factors were grouped, respectively, into the
clinical diagnosis of acute destructive cholecystitis, ultrasound diagnosis of acute destructive
cholecystitis, and functional liver test (Table 1).
Table 1
The number of patients with acute destructive cholecystitis identified by clinical,
ultrasound and laboratory examination
Variable
Clinical diagnosis
Ultrasound diagnosis Functional liver test
Diagnosis of acute
destructive
cholecystitis
27 (80,6%)
14 (38,7%)
22 (64,5%)
Diagnosis of acute
destructive
cholecystitis
24 (57,9%)
34 (84,2%)
30 (73,7%)
Diagnosis of acute
destructive
cholecystitis
8 (19,4%)
21 (61,3%)
13 (35,5%)
Diagnosis of acute
destructive
cholecystitis
18 (42,1%)
8 (15,8%)
12 (26,3%)
Clinically, the diagnosis of acute destructive cholecystitis was made in patients with pain in
the right hypochondrium and epigastrium for more than 12 hours, palpable gallbladder or
leukocytosis over 10700, with no positive Murphy's symptom, nausea, vomiting, and fever.
The diagnosis of acute destructive cholecystitis based on ultrasonographic data was based on
the detection of concretions in the lumen of the gallbladder with a possible insertion into the
neck, accompanied by an increase in transverse size over 34.9 mm, wall thickness over 3.0
Vo
lu
m
e
5,
Fe
br
ua
ry
,2
02
5
,
M
ED
IC
AL
SC
IE
N
CE
S.
IM
PA
CT
FA
CT
OR
:7
,8
9
mm with no stratification of the gallbladder wall, and the presence of a perimesical
accumulation of fluid. Additionally, in the diagnosis of acute destructive cholecystitis, a
functional liver test was used, such as an increase in total bilirubin above 13.2 mmol/l.
Sensitivity, specificity, prognostic value of positive and negative results, and accuracy of the
methods used were established. (Table 2).
Table 2
Diagnostic effectiveness of clinical, instrumental and laboratory research methods
Se
Sp
+PV
-PV
точность
Clinical diagnosis
80,6%
57,9%
53,2%
21,4%
68,1%
Ultrasound
diagnosis
38,7%
84,2%
27,3%
37,3%
63,8%
Functional liver test 64,5%
75,7%
41,7%
28,2%
70,6%
A clinical examination revealed acute destructive cholecystitis in 35 out of 42 people, and
acute cholecystitis in 26 out of 35 patients. Thus, the sensitivity of the clinical examination
was 80.6%, and the specificity was 57.9%. Ultrasound of the abdominal organs revealed
acute destructive cholecystitis in 15 patients, and acute cholecystitis in 34 patients. The
sensitivity of this method was 38.7%, and the specificity was 84.2%. An increase in
bilirubin levels was noted in 22 patients with acute destructive cholecystitis and remained
within normal limits in 31 patients with acute cholecystitis.
Clinical data, ultrasound data and liver functional test corresponding to acute destructive
cholecystitis were simultaneously detected in 6 patients; in all these patients, histological
examination confirmed acute destructive cholecystitis. Thus, the positive prognostic value of
simultaneous detection of all 3 groups of signs is 100%. On the other hand, all these signs
were absent in 12 patients, and 10 of them had a catarrhal form of acute cholecystitis
according to the results of a pathomorphological examination. Therefore, the absence of
these signs provides a positive prognostic value of 90%.
Cholecystectomy in acute destructive cholecystitis can be performed videolaparoscopically
or openly, without any significant differences in the levels of postoperative complications
and mortality. It has been shown that performing surgery within 72 hours of the onset of an
attack provides better results, especially when using laparoscopic techniques. In addition,
performing urgent surgery requires time and preparation, and certain material costs. All this
highlights the need to find accurate and timely methods for the detection of acute destructive
cholecystitis.
Early detection of destructive forms of acute cholecystitis is often associated with significant
difficulties. In the vast majority of cases, only such methods as medical history collection,
clinical examination, general and biochemical blood tests, ultrasound of the abdominal
organs are available in district hospitals. More expensive diagnostic tools and methods are
usually unavailable. Currently, instrumental diagnostic methods are becoming increasingly
important. The sensitivity of ultrasound in detecting cholelithiasis, according to the literature,
exceeds 90-95%, at the same time, its sensitivity in detecting acute destructive cholecystitis
is significantly lower. In this work, we have demonstrated that correct medical history
Vo
lu
m
e
5,
Fe
br
ua
ry
,2
02
5
,
M
ED
IC
AL
SC
IE
N
CE
S.
IM
PA
CT
FA
CT
OR
:7
,8
9
collection and clinical examination are simple, affordable, cost-effective methods that
surpass ultrasound in the diagnosis of acute destructive cholecystitis. On the other hand, the
high specificity of ultrasound makes it an extremely valuable method of excluding acute
destructive cholecystitis, although clinical examination is more sensitive than ultrasound in
detecting acute destructive cholecystitis, in practice they complement each other, and
sufficient accuracy in the diagnosis of acute destructive cholecystitis can be achieved if the
results of clinical examination, ultrasound and the results of functional liver tests coincide.
Ultrasound examination is used to confirm the diagnosis of acute destructive cholecystitis in
cases where it is suspected clinically. On the other hand, the diagnosis of acute destructive
cholecystitis can be ruled out with a sufficient degree of certainty if all these tests are
negative. These data suggest a fairly simple assessment of the patient's status, which makes
it possible to select those patients who need urgent surgery, as opposed to those who can be
operated on as planned.
Conclusion:
Thus, in order to timely resolve the issue of urgent laparoscopic
cholecystectomy in a regional hospital, the diagnosis of acute destructive cholecystitis with a
high degree of reliability can be established by identifying a combination of clinical,
ultrasound signs and changes in functional liver tests.
References:
1. Борисов, А.Е. Современное состояние проблемы лечения острого холецистита / А.
Е. Борисов [и др.] // Вестник хирургии им. Грекова. 2001. Т. 160. № 6. С. 92–95.
2. Yakubov F.R., Sapaev D.S., & Niyazmetov S.B. (2023). The treatment of the results of
pleural empyema complicated with bronchopleural fistula. Research Journal of Trauma and
Disability
Studies,
2(4),
241–
246.
http://journals.academiczone.net/index.php/rjtds/article/view/748
3. Yakubov F.R., Sapaev D.S. & Kuryazov B.N. (2023). Modern Aspects of Prevention of
Hernias of the Linea Alba of the Abdomen After Laparotomy. Research Journal of Trauma
and
Disability
Studies,
2(4),
139–142.
Retrieved
from
http://journals.academiczone.net/index.php/rjtds/article/view/702
4. Курьязов, Б. Н., Бабаджанов, А. Р., Рузматов, П. Ю., & Бабаджанов, К. Б. (2024).
Эффективность использования минилапаротомного доступа в хирургическом лечении
больных желчнокаменной болезни. Journal of Universal Science Research, 2(2), 373-381.
5. Rakhimov, I. R. (2023). Morphological changes in the pancreas in choledocholitiasis.
Art of Medicine. International Medical Scientific Journal, 3(1).
6. Yakubov F., Sadykov R., Niyazmetov S. & Sapaev D. (2023). Improving the method of
hemo-and aerostasis in lung surgery using the domestic hemostatic wound coating
"Hemoben". International Bulletin of Medical Sciences and Clinical Research, 3(10), 33–40.
https://researchcitations.com/index.php/ibmscr/article/view/2778
7. Cameron, K. Management of acute cholecystitis n UK: time for change / K. Cameron [et
al.] // Postgrad. Med. J. (2004) 80: 292–294.
Vo
lu
m
e
5,
Fe
br
ua
ry
,2
02
5
,
M
ED
IC
AL
SC
IE
N
CE
S.
IM
PA
CT
FA
CT
OR
:7
,8
9
8. Kolla, S.B. Early versus delayed laparoscopic cholecystectomy: a prospective randomized
trial / S. B. Kolla [et al.] // Surg. Endosc. (2004) 18:1323–1327.
9. Yakubov F.R. Sapaev D.S., Matkurbonov N.O., Ismoilov A.O. (2025). Results of modern
treatments
for
destructive
forms
of
cholecystitis
in
old
age.
https://doi.org/10.5281/zenodo.14759162
10. Петри, А. Наглядная статистика в медицине / А. Петри, К. Сэбин. М.: ГЭОТАР-
МЕД, 2003. 144 с.
