title: [Etiology of "difficult" laparoscopic cholecystectomy].
abstract: OBJECTIVE
  To define causes of difficult situations in various forms of acute cholecystitis depending on terms of disease and clinico-morphological changes in gall bladder area and to justify differentiated application of laparoscopic surgery for acute cholecystitis.
  
  
  METHODS
  It was reviewed 1132 medical records of patients with acute cholecystitis. It is found that morphological changes in gall bladder and surrounding tissues depend on duration of follow-up of patients with acute cholecystitis and type of inflammation.
  
  
  RESULTS
  In acute catarrhal cholecystitis "complicated" intraoperative situations are observed in 37.5% due to "loose" tissues infiltration, in phlegmonous and gangrenous forms of inflammation - in 44.6% and 63.6% respectively due to "dense" infiltrates development.
  
  
  CONCLUSIONS
  Technical variants of laparoscopic cholecystectomy for various "difficult" intraoperative situations are suggested.
authors.affiliation: Chair of Surgery with Endosurgical Course, Faculty of Additional Postgraduate Education of acad. I.P. Pavlov Ryazan State Medical University.
authors.forename: V P
authors.initials: VP
authors.lastname: Sazhin
authors.affiliation: Chair of Surgery with Endosurgical Course, Faculty of Additional Postgraduate Education of acad. I.P. Pavlov Ryazan State Medical University.
authors.forename: I V
authors.initials: IV
authors.lastname: Sazhin
authors.affiliation: Chair of Surgery with Endosurgical Course, Faculty of Additional Postgraduate Education of acad. I.P. Pavlov Ryazan State Medical University.
authors.forename: I A
authors.initials: IA
authors.lastname: Pod''iablonskaia
authors.affiliation: Chair of Surgery with Endosurgical Course, Faculty of Additional Postgraduate Education of acad. I.P. Pavlov Ryazan State Medical University.
authors.forename: D I
authors.initials: DI
authors.lastname: Karlov
authors.affiliation: Chair of Surgery with Endosurgical Course, Faculty of Additional Postgraduate Education of acad. I.P. Pavlov Ryazan State Medical University.
authors.forename: A V
authors.initials: AV
authors.lastname: Nuzhdikhin
authors.affiliation: Chair of Surgery with Endosurgical Course, Faculty of Additional Postgraduate Education of acad. I.P. Pavlov Ryazan State Medical University.
authors.forename: S A
authors.initials: SA
authors.lastname: Aĭvazian
mesh_terms: D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000379:methods; D041881:Cholecystitis, Acute / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005704:Gallbladder / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D007249:Inflammation; D007431:Intraoperative Complications / Q000175:diagnosis / Q000209:etiology; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care