Analysis of the Reasons of Intraoperative Problems in Laparoscopic Cholecystectomy in Elderly and Senilepatients with Acute Calculous Cholecystitis
We analyzed the surgical treatment of 173 elderly and senile patients with acute calculous cholecystitis. In all patients the diagnosis was confirmed intraoperatively and histologically. Age of the patients ranged from 61 to 89 years old (average 72.4 ± 8.7). Depending on the clinical course of cholecystitis patients were divided into two groups. The basic group included 90 patients with prominent local and systemic changes typical for acute inflammation of the gallbladder. The comparison group included 83 patients without expressed clinical picture of acute cholecystitis. The admission diagnoses were chronic calculous cholecystitis (65.1 %), acute edematous pancreatitis (22.9 %), acute intestinal obstruction (7.2 %) and hepatic colic (4.8 %). In all patients acute calculous cholecystitis was diagnosed within 6–12 hours or more after admission to hospital or during intervention. Laparoscopic cholecystectomy was performed in 76 patients of the basic group and 65 parsons of the comparison group. The need for conversion and holding the incision cholecystectomy through laparotomy was in 11 patients of the basic group and in 9 parsons of the comparison group. Cholecystectomy was completed with endoscopic sanitation on common bile duct in 2 patients in the basic group and in 8 persons of the comparison group. The typical resons of intraoperative difficulties in performing laparoscopic cholecystectomy in patients of the basic group were expressed infiltrative changes in gallbladder wall (70.0 %), cervical infiltration of the gallbladder (43.3 %), intraoperative perforation of the bladder wall (24.4 %), infiltration areas of the bladder body (23.3 %), bleeding from the bed of the gallbladder (20.0 %), while the comparison group patients had infiltration in the body of the gallbladder (50.6 %), wall infiltrative changes (49.4 %), infiltrated bladder neck (37.3 %) and intraoperative perforation of the gallbladder (18.1 %). Among the comparison group patients twice as often there were cases of reduced and thick gallbladder. Intraoperative bleeding from the cystic artery was observed in 5.6 % in the study group and in 4.8 % in the comparison group. Mostly common gallbladder artery was a branch of the right hepatic artery (70.5 %) among these patients damage was observed in 2.3 % (3/122). The lowest incidence of intraoperative bleeding was recorded at discharge cystic artery from the left hepatic artery or gastroduodenal artery — 0.6 % (1/42), and the highest one in the doubling of cystic artery — 5/9.
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