Аbstract. The significance of the problem of acute cholecystitis in the elderly and senile is due to a high increase in the incidence, the presence of marked concomitant diseases. There is no literature data on a comparative analysis of early post-surgery complications of acute destructive cholecystitis in elderly and senile patients with concomitant coronary heart disease after traditional cholecystectomy and laparoscopic cholecystectomy. The Aim of the study is a comparative analysis of the nature of early post-surgery complications after traditional cholecystectomy and laparoscopic cholecystectomy of acute destructive cholecystitis in the elderly and senile with concomitant coronary heart disease. Materials and methods of research. A comparative analysis of early post-surgery complications was performed in 392 patients aged 60 and over with concomitant coronary heart disease who underwent surgical treatment for acute destructive cholecystitis. Depending on the method of surgical treatment, patients were divided into two groups: the І group (n = 178) — surgical treatment was carried out in the amount of traditional cholecystectomy, sanitation of the abdominal cavity with saline and decasan solution; the ІІ group (n = 214) — surgical treatment included laparoscopic cholecystectomy, sanitation of the abdominal cavity with saline and «decasan» solution, extraction of the gallbladder in a rubber sterile container through a subxiphoid wound, which, after removal of the gallbladder, was sanitized with «decasan» solution. Research results. Complications from the cardiovascular system in the 1st group were noted in 2.8 % of patients, pneumonia — 1.1 %, from the abdominal cavity — 8.5 %, wounds — 25.8 %, postoperative intestinal paresis — 19, 1 %, mortality — 1.1 %. In the 2nd group, complications from the cardiovascular system — 0.5 %, from the abdominal cavity — 4.7 %, wounds — 4.2 %, postoperative intestinal paresis — 8.4 %, mortality — 0.5 %. Complications related to bile leakage, the development of biloma or biliary peritonitis in the groups did not differ. Conclusions. The use of laparoscopic cholecystectomy in acute destructive cholecystitis in elderly people with concomitant coronary heart disease has reduced the number of postoperative complications from the cardiovascular system compared with traditional cholecystectomy from 2.8 % to 0.5 %, from the abdominal cavity — from 8.5 to 4.7 %, from the side of the wound — from 25.8 to 4.2 %, reduce mortality from 1.1 to 0.5 %.

Summary. Elderly and senile patients in surgery are associated with numerous concomitant diseases, reduced functional reserve and high anesthetic risk. Aim. To assess the frequency and nature of perioperative complications in elderly and senile patients after laparoscopic cholecystectomy for acute or chronic calculous cholecystitis. Materials and methods. We analyzed the qualitative and quantitative characteristics of intraoperative and postoperative complications in 180 patients aged 60 to 90 years (elderly and senile) after laparoscopic cholecystectomy for acute or chronic calculous cholecystitis. The comparison group consisted of 200 patients aged 25 to 44 years. The procedure of choice in all patients was laparoscopic cholecystectomy. Results. In elderly and senile patients, intraoperative complications occurred more often (p<0.05) than in patients under 44 years of age. No significant differences were observed only in the frequency of intraoperative bleeding from the gallbladder artery, in the intrahepatic localization of the gallbladder, in the frequency of local peritonitis and gallbladder hydrops. In 20 (11.1 %) cases, there was a need for conversion (p=0.0002). Complications occurred in 29.4 % of cases, against 10.5 % in young patients (p<0.001). The difference in the number of minor complications: Clavien Dindo-1, Clavien Dindo-2 and Clavien Dindo-2a was improbable. Clavien Dindo-2b (5.0 %) (p<0.05), Clavien Dindo-3 (5.0 %) (p<0.05) and Clavien Dindo-4 (4.4 %) (p<0.05) complications occurred more often. Conclusions. Patients over 60 years of age are more likely (p<0.05) to have intraoperative problems during laparoscopic cholecystectomy and have a higher (p<0.05) risk of severe complications that require invasive procedures or may cause patient death.

Introduction.In an environment where skills, practical skills and theoretical knowledge are rapidly becoming obsolete, one of the most important factors in providing quality medical care to the population of the City Clinical Hospital (MCL) of Ukraine is the ability to constantly improve the professional level of its employees. In this context, the strategic goals in the direction of improving the efficiency of MCL of Ukraine, the greatest attention is paid to creating conditions aimed at the possibility of professional growth of professionals and their motivation, the formation of a favorable socio-psychological climate [1, p. 56].Continuous professional development of MCL employees in Ukraine is necessary to improve the quality of medical care. The lack of continuous education of MCL employees will stop their development as specialists, which will naturally affect the quality of medical care. The process of continuous professional training, throughout life, of employees of medical

The aim —  to assess the incidence of port site infection after laparoscopic cholecystectomy and laparoscopic cholecystectomy with bacteriophage therapy for acute destructive cholecystitis.Materials and methods. The analysis of the results of treatment of 96 patients with obesity of I — II stages at the age of 37 to 67 years carried out. All patients underwent laparoscopic cholecystectomy for acute destructive cholecystitis. The average body mass index was 35.04 ± 0.2 kg/m2. In the comparison group (n = 42), the subxiphoid trocar wound was sanitized with a 0.02 % decamethoxin solution in an isotonic sodium chloride solution (decasan solution) after gall bladder extraction. In the main group (n = 54), the subxiphoid trocar wound was irrigated with therapeutic and prophylactic bacteriophages (Sextaphag, Intesti‑bacteriophage, coli protein bacteriophage, and their combination). Treatment results were evaluated by the nature and frequency of infection of the trocar wound area.Results and discussion. Infiltrate and/or seromas of trocar wounds in the comparison group have observed in one (2.4 %) patient, in the main group — in 2 (3.7 %) patients. Suppuration of the trocar wound has observed only in the comparison group — 2 (4.8 %) cases. The nature of microbial bile flora and the exudate of the abdominal cavity, its amount, the sensitivity of microorganisms to antibiotics and bacteriophages were studied. In patients with gangrenous cholecystitis and local purulent peritonitis, microbial associations prevailed (65.9 %), Pseudomonas aeruginosa, Candida strains and anaerobic flora were detected. In patients with phlegmonous form of cholecystitis, the sensitivity of Escherichia coli, Staphylococci, Streptococci, Proteas and Klebsiella to Sextaphag was 76.9 — 100.0 %.Conclusions. The bacteriophage therapy after laparoscopic cholecystectomy for acute destructive cholecystitis contributed to a reduction of port site infection incidence in the postoperative period from 8.5 to 2.4 %.

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