[Choice of surgical approach in laparoscopic cholecystectomy]

A definition of a surgical access in laparoscopic interventions is formulated. The importance of use of various surgical accesses is stressed. The results of treatment of 410 patients with calculous cholecystitis are analysed. 72 of the patients have been previously operated on abdominal cavity. The cause of technical mistakes and failures are analysed. The original method of ultrasound evaluation of abdominal cavity adhesions in patients, who had been operated on previously is proposed. The method was used in 45 patients, and in 95% of the cases the evaluation was perfectly accurate. Indications for use of a particular surgical access, depending on a site of a previous operation, are formulated. The method of an open laparoscopy is described. It is indicated in case of previously performed low-middle laparotomy and ultrasonic picture of adhesions in the umbilical region; in umbilical hernias; in big and multiple choleliths (more than 30 cubic cm of total volume).