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.
Full Text:PDF (Українська)
Abdullah M. Diagnostic approach and management of acute abdominal pain / M. Abdullah, M.A. Firmansyah // Acta Med. Indones. — 2012 Oct. — 44(4). — P. 344-350.
The safety and prognostic factors for mortality in extremely elderly patients undergoing an emergency operation / S.Y. Park, J.S. Chung, S.H. Kim [and other] // Surg. Today. — 2015 Mar. — 19.
Acute cholecystitis in elderly patients after hip fracture: Incidence and epidemiology / S.K. Choo, H.J. Park, H.K. Oh, Y.K. Kang, Y. Kim // Geriatr. Gerontol. Int. — 2015 Mar. — 21.
Le V.H. Conversion of laparoscopic to open cholecystectomy in the current era of laparoscopic surgery / V.H. Le, D.E. Smith, B.L. Johnson // Am. Surg. — 2012 Dec. — 78(12). — Р. 1392-1395.
Семенюк Ю.С. Досвід виконання лапароскопічної холецистектомії / Ю.С. Семенюк, В.А. Федорук, І.В. Сидорук, О.В. Повійко, В.Г. Мініч // IV Міжнародні Пироговські читання: Міжнародний науковий конгрес, 2–5 червня 2010 р.: Тези доп. — Вінниця, 2010. — С. 136-137.
Gurgenidze M. Miniinvasive surgical management of cholelithiasis for elderly and senile patients: a retrospective study / M. Gurgenidze, M. Kiladze, Z. Beriashvili // Georgian Med. News. — 2013 Jun. — 219. — Р. 7-13.
Sex differences and outcomes of management of acute cholecystitis / M. Nikfarjam, E. Harnaen, F. Tufail [and other] // Surg. Laparosc. Endosc. Percutan. Tech. — 2013 Feb. — 23(1). — Р. 61-65.
Ничитайло М. Лапароскопічна холецистектомія в умовах гострого холециститу / М. Ничитайло // Науковий вісник Ужгородського університету, серія «Медицина». — 2003. — № 21. — С. 194-196.
Copyright (c) 2016 UKRAINIAN JOURNAL OF SURGERY
This work is licensed under a Creative Commons Attribution 4.0 International License.
© Publishing House Zaslavsky, 1997-2019