BACKGROUND
The problem of topographic and anatomical justification of operative access in gallbladder surgery in obese patients is the most important issue in the treatment of gallstone disease.
OBJECTIVE
To clarify the features of the holotopy of the bottom and the neck of the gallbladder in relation to the anterior abdominal wall depending on the anthropometric characteristics of the subject in the presence of obesity and without it.
MATERIAL AND METHODS
The present work includes data on the results of anthropometry and multi-spiral computed tomography of abdominal organs of 326 adult patients without cholelithiasis diseases in their anamnesis. The study was carried out on the clinical basis of the Department of Operative and Clinical Surgery with Topographic Anatomy named after S.A. Simbirtsev The North-Western State Medical University named after I.I. Mechnikov. During the first stage the visualization of the Ker point the bottom and neck of the gallbladder on tomograms was performed; mathematical analysis and modeling of the position of the examined organ were carried out depending on the anthropometric data of the patient. At the second stage, the thickness of subcutaneous fat in the area of the alleged operative access and its fraction in the distance from the skin surface of the anterior abdominal wall to the bottom or neck of the gallbladder were evaluated.
RESULTS
Many points are obtained reflecting the mutual position of the Ker point, the bottom and neck of the gallbladder on the plane (projection of the bottom and neck of the gallbladder on the surface of the anterior abdominal wall) and in three-dimensional space. The distribution of the coordinates of the Ker point, bottom and neck of the gallbladder on the plane and in three-dimensional space looked normal. To characterize the location of the bottom and neck of the gallbladder the dispersion ellipses were used; the main numerical characteristics of which reflect the law of normal distribution of points on the plane. Centers of scattering ellipses for the gallbladder bottom and neck in each of the studied groups, as well as in the total sample were obtained. The centers of the scattering ellipse for the gallbladder neck in all the groups under study do not coincide with the center of the Ker point scattering ellipse. The centers of scattering ellipses for the bottom of the gallbladder have greater variability than the centers of scattering ellipses for the neck of the gallbladder. The greatest thickness of the subcutaneous fat layer in the area of the projection of the gallbladder on the anterior abdominal wall was revealed in the examined female hyperstenic physique — 31±16 mm, the smallest — in the examined male asthenic physique — 8±5 mm.
CONCLUSION
Data on the options for the location of the gallbladder bottom and neck and the thickness of subcutaneous fat in the area of intended operative access were obtained and their dependence on the anthropometric characteristics of the patient should be taken into account at the stage of planning surgical treatment in order to reduce operational injury.
