SURGICAL TECHNOLOGIES FOR SIMULTANEOUS OPERATIONS IN PATIENTS WITH CONGENITAL HEMOLYTIC ANEMIAS AND CHOLELITHIASIS

Abstract. Introduction. Hereditary microspherocytosis (HMS) is a disorder characterized by defects in erythrocyte membranes, leading to their destruction in the spleen and disturbances in bilirubin metabolism. Among the most common complications of HMS is cholelithiasis. Splenectomy (SE) and laparoscopic cholecystectomy (LC) are effective treatment methods. The aim of the study is to evaluate the effectiveness of simultaneous surgeries (SS) using laparoscopic techniques in the combination of cholelithiasis and hereditary microspherocytosis (HMS). Materials and methods: In 13 patients with hereditary microspherocytosis (HMS), cholelithiasis was diagnosed, and these patients underwent simultaneous splenectomy (SE) and cholecystectomy (CE). All patients underwent comprehensive laboratory and instrumental diagnostics. In 5 patients, laparoscopic access was used for simultaneous surgery (LCE + LSE), while in 8 patients, a hybrid procedure was performed (LCE + laparotomic SE). Video laparoscopic surgical interventions were performed using the Karl Storz system (Germany). Intraoperatively, the “Harmonic Scalpel Ultracision” ultrasonic device (Ethicon, USA) was used as a dissector and coagulator, while Endo-GIA staplers (Autosuture, USA) were used for vascular pedicle management of the spleen. Results and discussion: In 8 patients, simultaneous surgery (SS) was performed using a hybrid technique that combined laparoscopic and laparotomic access. In 5 patients, SS was performed entirely using the laparoscopic method. Spleen mobilization with an ultrasonic scalpel was carried out quickly, as the division of ligaments and adhesions was not accompanied by bleeding. Proper preoperative preparation, the correct choice of surgical access and technique for combined SE and CE using an ultrasonic scalpel and stapling device, along with adequate postoperative therapy, help prevent technical errors, postoperative complications, and significantly improve outcomes in patients with HMS. The simultaneous performance of SE and CE does not increase the severity of the surgical procedure or the postoperative course. Conclusions: 1. The use of an extended diagnostic program for hereditary microspherocytosis (HMS) complicated by cholelithiasis allows for a well-founded determination of surgical tactics and the selection of the optimal surgical approach. The use of an ultrasonic scalpel and linear stapler during splenectomy in patients with HMS significantly facilitates spleen mobilization, reduces intraoperative blood loss, and minimizes the risk of intraand postoperative complications. The application of laparoscopic and hybrid techniques for simultaneous surgery (SS) in HMS complicated by cholelithiasis helps avoid the need for repeat surgical intervention, ensures high treatment efficacy, and provides significant medical and social benefits compared to performing two separate procedures.