Laparoscopic sanitation combined with cholecystostomy and catheterization via the round ligament of the liver followed by heptral administration in the complex treatment of patients with severe pancreatitis complicated by enzymatic peritonitis

Severe acute pancreatitis is accompanied by persistent organ failure and progressive endotoxicosis, which quite often leads to a fatal outcome. The search for new treatment methods remains a urgent scientific and practical challenge. Objective. The aim of the study is to evaluate the effectiveness of laparoscopic abdominal debridement combined with cholecystostomy and catheterization via the round ligament of the liver, followed by ademetionine administration in the complex treatment of patients with severe pancreatitis complicated by enzymatic peritonitis. Materials and Methods. A total of 38 patients were examined. The first group consisted of 17 patients whose treatment, in addition to standard therapy, included early laparoscopic abdominal debridement combined with cholecystostomy and catheterization via the round ligament of the liver, followed by ademetionine administration. The second group consisted of 21 patients who were treated according to the current version of clinical guidelines, including surgical interventions when indicated. The study concept is based on the fact that ademetionine, being a hepatoprotector, along with other properties, has a pronounced choleretic effect, including in cases of intralobular cholestasis. Ademetionine use in acute pancreatitis should not only protect the liver but also activate the natural detoxification process. Furthermore, drug administration into the round ligament of the liver, despite the relative technical simplicity of the method, should significantly increase drug absolute bioavailability. Cholecystostomy can prevent the potential development of biliary hypertension during treatment. Results. The observed a significantly more pronounced normalization of blood amylase, leukocyte intoxication index, urea and fibrinogen levels. The need for reoperation in the first group occurred 4.8 times less frequently than in the second one. Mortality and the average length of hospital stay were reduced. Conclusion. The proposed method for treating patients with severe pancreatitis complicated by enzymatic peritonitis is effective, as it reduces the incidence and severity of complications, improves key clinical and laboratory parameters, and the quality of life.