Background: Cholelithiasis is one of the most common issues affecting the gastrointestinal tract. The prevalence of cholelithiasis ranges from 11% to 36%. The prevalence is found to be associated with a number of factors including age, gender and ethnicity. Women have three times higher risk of developing this condition in comparison to men. Objective: This The aim of this study is to prove that occurrence of early and late postoperative complications is lower in patients who had three metal clips placed on cystic artery and ductus cysticus in comparison to the patients who had two metal clips placed. Methods: In this retrospective study we included all the patients who underwent acute laparoscopic cholecystectomy between January 1st 2021 and December 31st 2022 at the Department of Abdominal Surgery of University Clinical Centre Tuzla. Total number of patients included in the study is 148. A total of 1200 laparoscopic cholecystectomies were performed, of which 1052 patients had chronic calculus cholecystitis, and the performed laparoscopic cholecystectomies were part of elective surgical procedures. Remaining 148 patients had acute calculus cholecystitis, and were admitted and operated laparoscopically in an emergency protocol. Results:: Out of total amount of 82 laparoscopic surgeries were performed with the placement of two clips on the cystic artery and cystic duct, and 66 laparoscopic cholecystectomies with the placement of three clips on the cystic artery and cystic duct. Out of a total of 82 patients who were implanted with two clips, 6 of them had some of the postoperative complications. In the group of patients who had three clips implanted, none of the 66 subjects had any postoperative complications. Conclusion:: The study confirms that patients who underwent placement of three clips had lesser odds of developing complications, and that this occurrence is not accidental but rather a consequence of the choice of the surgical method.

Background: The frequency of severe chest injuries are increased. Their high morbidity is followed by systemic inflammatory response. The efficacy of pharmacological blockade of the response could prevent complications after chest injures. Aim: The aim of the study was to show an inflammatory response level, its prognostic significant and length of hospital stay after chest injures opiate analgesia treatment. Methods: Sixty patients from Department of Thoracic Surgery with severe chest injures were included in the prospective study. With respect of non opiate or opiate analgesia treatment, the patients were divided in two groups consisted of 30 patients. As a inflammatory markers, serum values of leukocytes, neutrophils, C-reactive protein (CRP) and fibrinogen in three measurements: at the time of admission, 24hours and 48 hours after admission, were followed. Results: Statistically significant differences were found between the examined groups in mean serum values of neutrophils (p=0.026 and p=0.03) in the second and the third measurement, CRP (p=0.05 and 0.25) in the second and the third measurement and leukocytes in the third measurement (p=0.016). 6 patients in group I and 3 in group II had initial stage of pneumonia, 13 patients in group I and 6 in group II had atelectasis and 7 patients from group I and 4 from group II had pleural effusion. The rate of complications was lower in group of patient who were under opiate analgesia treatment but without significant difference. The length of hospital stay for the patients in group I was 7.3±1.15 days and for the patients in group II it was 6.1±0.87 days with statistically significant difference p=0.017. Conclusion: The opiate analgesia in patients with severe chest injures reduced level of early inflammatory response, rate of intra hospital complications and length of hospital stay.