Beneficiile CL in abordarea litiazei biliare, cit si colelitiaza consecutiva interventiilor chirurgicale laborioase abdominale, asociate cu un proces aderential extins, sunt expuse pe larg in literatura. Ramine insa discutabila posibilitatea utilizarii CL in solutionarea acestor cazuri de colelitiaza. Material si metode: Este expusa analiza a 43 (1,63%) cazuri de CL efectuate la pacienti cu interventii abdominale anterioare (IAA), selectate din 2636 cazuri de CL, tratate in SC „Sf.Arh.Mihail” in perioada 2012 – 2021. Conform principiului etiologic al IAA, pacientii au fost divizati: 23(53,4%) - IAA gastrice, 20(46,6%) - IAA diverse. Dependent de schimbarile morphologice colecistice: 21 (48,8%) - colecistita litiazica acuta necomplicata (CLA) si 22(51,2%) colecistita litiazica cronica (CLC). Rezultate: CL s-a practicat prin metoda clasica cu 4 porturi. Incizia laparotomica a fost in toate cazurile supraombilicala, in cadranul abdominal drept, cu 1 cm lateral de cicatricia postoperatorie. Aplicarea primului port s-a efectuat sub control digital, cu omiterea insuflarii preliminare de CO2 prin acul Veress. Dupa visceroliza partiala superioara trocarele ajutatoare amplasate tipic. Durata interventiei in CLA – 65,6 ? 16,4min, in CLC – 54,6 ? 15,4min. Conversii - 6 (13,9%), in CLA – 5 in CLC - 1. Toate conversiile au fost la pacienti cu IAA gastrice, care au prezentat o anatomie mai dificila a planseului bilio-pancreatic. Complicatii postoperatorii 1 caz- supurare a plagii dupa conversie, 8 cazuri de ocluzie dinamica prelungita postoperatorie, rezolvate prin tratament medicamentos. Concluzii: Staza doudenala ce survine intr-un proces aderential extins dupa IAA, ramine a fi cauza etiologica principala a colelitiazei la acesti pacienti. Indiferent de faptul, ca prin prezenta de aderente extinse si schimbari morfologice progresive ale veziculei inflamate, CL prezenta un risc operator dublu, procedura are indicatii la pacienti cu IAA si abordarea devine mai sigura atunci cind este efectuata cu o tehnica bine determinata.

The benefits of LC in the approach to gallstones, as well as cholelithiasis following abdominal laborious surgery, associated with an extensive adhesion process, are widely presented in the literature. However, the possibility of using LC in solving these cases of cholelithiasis remains debatable. Material and methods: The analysis of 43 (1,63%) cases of LC performed in patients with previous abdominal interventions (PAI), selected from 2636 cases of LC, treated in „Sn. Arch. Michael” Hospital during 2012 - 2021. According to the etiological principle of PAI, the patients were divided: 23(53,4%) - gastric PAI, 20(46,6%) - various PAI. Depending on the morphological changes of the gallbladder: 21 (48,8%) - uncomplicated acute lithiasic cholecystitis (ALC) and 22(51,2%) - chronic lithiasic cholecystitis (CLC). Results: LC was practiced by the classic 4-port method. The laparotomy incision was in all cases supraumbilical, in the right abdominal quadrant, 1 cm lateral to the postoperative scar. The application of the first port was carried out under digital control, with the omission of the preliminary insufflation of CO2 through the Veress needle. After upper partial viscerolysis - typically placed auxiliary trocars. The duration of the intervention in ALC - 65.6 ? 16.4 min, in CLC - 54.6 ? 15.2 min. Conversions - 6 (13,9%), to ALC - 5 to CLC - 1. All conversions were in patients with gastric PAI, who presented a more difficult anatomy of the biliary-pancreatic region. Postoperative complications: 1 case - suppuration of the wound after conversion, 8 cases of prolonged postoperative dynamic occlusion, solved by drug treatment. Conclusions: Stasis in the duodenum that occurs in an extended adhesion process after PAI, remains the main etiological cause of cholelithiasis in these patients. Regardless of the fact that, due to the presence of extensive adhesions and progressive morphological changes in the inflammation of the gallbladder, LC presents a double operative risk, the procedure has indications in patients with PAI and the approach becomes safer when performed with a well-defined technique.