<b>Introduction:</b> In today’s technological climate, science and medicine have entered a new era. At the level of technological progress, we have identified millennia of “new” problems and diseases. If earlier diseases had a certain individuality then, in the third millennium, we face compliance and synergistic influence of diseases. Obesity is a problem of the third millennium. It is known that obesity is the main factor in the development of various chronic diseases [1–3]. With excess weight and obesity, bile is oversaturated with cholesterol, resulting in an increase of its lipogenicity index. As a result, frequency of gallstone disease increases; findings from this study document an increase of disease frequency as high as 50% to 60% [4]. In 20% of patients, housing concerns are combined with obesity [5]. Thus, obesity is one of the factors in the development of cholelithiasis and cholecystitis [6]. The presence of acute cholecystitis represents the most difficult situation for patients with gallstones. When obesity is also present, the patient’s risk of surgical complications increases due to altered homeostasis and reduced reserve capacity [7]. A retrospective study of this issue [8] posed a number of questions about the possibility of influencing the course of disease in the preoperative period as well as the improvement and impact of surgical technicalities in patients with acute cholecystitis and obesity. Addressing these and additional questions is the main goal of this study. <br><b>Aim: </b>The aim of the study was to study and select the optimal method of surgery in patients with acute cholecystitis and obesity. <br><b>Materials and methods:</b> In our study, a prospective analysis was used. We analyzed 67 cases with diagnosis of acute cholecystitis and obesity; all were treated at Kyiv Regional Clinical Hospital in the period from September 2018 to March 2020. Patients with acute cholecystitis and obesity received either traditional or modified laparoscopic cholecystectomy. <br><b>Results:</b> Retrospective analysis indicates traditional laparoscopic cholecystectomy is technically difficult and costly in patients with acute cholecystitis and obesity. A modified laparoscopic cholecystectomy has been proposed to improve and enhance surgery in patients with acute cholecystitis and obesity. Surgical duration was shortened by 9.01 ± 0.41 minutes (p = 0.001; αα= 0.05) when a modified laparoscopic cholecystectomy was performed. <br><b>Conclusions:</b> Performing a modified laparoscopic cholecystectomy reduced the duration of surgery by 9.01 ± 0.41 minutes (p = 0.001; α = 0.05), prevents development of metabolic acidosis pH 7.39 ± 0.03 vs 7.30 ± 0.005 = 0.001; αα= 0.05, pCO2 5.05 ± 0.36 vs 6.03 ± 0.38 (p = 0.02; αα= 0.05), reducing the risk of hypercoagulation. Modified laparoscopic cholecystectomy (LHE) is effective in II and III degrees of obesity (p = 0.001; α = 0.05).

Reducing the complications of the peritoneal dialysis (PD) procedure prolongs its use. The purpose of the work was to justify prolongation of peritoneal dialysis by modifying its setting. The study included 54 patients with chronic renal insufficiency, they carried out laparoscopic setting of PD; 14 patients were with omentopexy and 40 – with a classical statement. The operation was performed under general anesthesia. Surgical tactics were as follows: omentum folds were fixed to the parietal peritoneum; the control catheter was inserted through the window into the mesentery of the colon, and the dialysis portion at the bottom of the pelvis; sutured the window of the mesentery of the colon. Before insertion of the camera port, pneumoperitoneum was induced with a Veress needle, 10 mm below the navel. The pressure of abdominal gas was 12 mm Hg. Art. The point of entry into the abdominal cavity was established by the Hassan method: 5 cm lateral and 7 cm below the navel along the outer edge of the rectus abdominis muscle. A control catheter was inserted into the window under the transverse colon and inflated the balloon, the omentum was fixed to the parietal peritoneum 3 cm above the navel and the window in the colon mesentery was sutured. All early and late postoperative complications of the patients were recorded for 12 months (wound infections, including “tunnel infection”, dialysate leakage past the catheter, obturation of the catheter lumen, loss of tightness of omentoperitoneopexy). The study included 8 men and 6 women, aged from 43 to 76 years, of whom 2 patients had previously been operated on the abdominal organs. The operative intervention time averaged 54,6±15,4 min. No obstruction, catheter migration, or “tunnel infection” was established during the study. We have developed a laparoscopic technique of peritoneopexy of the upper half of the abdominal cavity, which will be used when the resource of the lower half of the abdominal cavity is exhausted and the effectiveness of preventing mechanical complications of the catheter PD has been proven.