Simultaneous laparoscopic procedures for concomitant abdominal diseases: A comparative observational non-randomized study

Background . Abdominal surgical conditions are among the most prevalent in emergency surgery. The high frequency of concomitant diseases and the need to select the optimal treatment strategy underscore the importance of implementing simultaneous laparoscopic procedures, which can minimize surgical trauma and improve outcomes. Objective. To evaluate the clinical efficacy and safety of simultaneous laparoscopic procedures in the treatment of concomitant abdominal surgical diseases. Methods . A comparative, observational, non-randomized clinical study was conducted to evaluate the outcomes of 120 patients with calculous cholecystitis concomitant with other abdominal surgical diseases (physical status class I–III). Through exact matching by age and pathology, two groups were formed to be comparable in key anthropometric data and physical status according to the American Society of Anesthesiologists classification. The main group (n = 60) underwent simultaneous laparoscopic procedures performed according to an original algorithm using a precision dissection technique, while the control group underwent simultaneous open surgeries (n = 60). The study assessed intraoperative parameters, complication rates according to the Clavien–Dindo classification, autonomic regulation dynamics using the Index of Regulatory System Activity, and long-term quality of life (the 36-Item Short Form Health Survey, or SF-36) at 12 months. Statistical analysis was performed employing IBM SPSS Statistics 26.0 (IBM Corp., USA) and Microsoft Excel 2016 software (Microsoft, USA), with the use of Student’s t-test, Mann—Whitney U test, and Pearson’s chi-square test. A p-value of < 0.05 was considered statistically significant. Results. The combination of laparoscopic procedures resulted in a 39.4% reduction in mean operative time (95.2 ± 12.5 vs. 157.1 ± 16.5 min in the open surgery group; p = 0.011) and a 2.2-fold decrease in blood loss (120 ± 30 vs. 260 ± 40 mL; p = 0.014). The overall complication rate in the main group was 4.1 times lower than in the control group (11.7% vs. 48.3%; p = 0.0001), while the risk of severe postoperative complications (Grade IIIb) decreased fourfold (5.0% vs. 20.0%; p = 0.012). Postoperative mortality was 0% in the laparoscopic group and 5.0% in the control group. By Day 7, the Index of Regulatory System Activity in the main group had normalized (3.4 ± 0.9 points), whereas functional stress persisted in the open surgery group (5.5 ± 0.7 points; p < 0.001). Length of hospital stay was 1.6 times shorter (6.4 vs. 10.2 days; p = 0.009). One year after simultaneous laparoscopic procedures, the SF-36 Physical Component Summary score improved by 41%, significantly exceeding the 24% improvement observed in the control group (p = 0.011). Conclusion . Simultaneous laparoscopic procedures performed for concomitant abdominal diseases demonstrate high clinical efficacy and safety. This approach reduces the operative time, minimizes blood loss, lowers complication rates, and accelerates patient recovery. These findings support the widespread adoption of this method in abdominal surgery.

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