Surgical Tactics in Treatment of Complicated Forms of Cholelithiasis in Elderly and Senile Patients

O.Ye. Kanikovsky, O.I. Bondarchuk, Ya.V. Karyi, Ye.V. Babiychuk, I.V. Pavlyk

Abstract


Objective of the Research. To study the efficiency of single- and two-stage surgery in the treatment of complicated forms of cholelithiasis in elderly and senile patients.
Material and Methods. During 2002–2013 years in the surgical clinic we had treated 320 patients with complicated forms of cholelithiasis. The age of patients — 70 to 89 years. Comorbidities were diagnosed in 228 (71.2 %) patients.
Results. Single-stage bile duct surgery has been performed in 68 (21.2 %), two-stage — in 46 (14.4 %) patients. Complications after single-stage surgery were diagnosed in 6 (8.8 %), after a two-stage — in 3 (6.5 %) cases. 1 patients died after a single-stage surgery.
Conclusions. Two-stage surgical tactics in complicated forms of cholelithiasis in elderly and senile patients are priority because it makes it possible to reduce the incidence of postoperative complications in 2 times. Two-stage surgery include: carrying out laparoscopic cholecystectomy (LCE), followed by endoscopic papillosphincterotomy (EPST) in the early postoperative course of acute calculous cholecystitis and EPST with further LCE in patients with chronic course. One-stage surgeries (LCE with bile ducts interventions) are possible in acute cholecystitis complicated by loose paravesical infiltrate, as well as in and absence of sclerotic gallbladder and excessive adhesive process in chronic cholecystitis.


Keywords


cholelithiasis; laparoscopic and open cholecystectomy; endoscopic papillosphyncterotomy

References


Балалыкин А.С. Эндоскопическая диагностика и лечение доброкачественных новообразований большого дуоденального сосочка / Балалыкин А.С., Гвоздик В.В., Звягинцев В.В. // Мат-лы третьего международного хирургического конгресса «Научные исследования в реализации программы «Здоровье населения России». — М., 2007. — С. 145.

Грубник В.В., Ковальчук А.Л., Дюжев А.С. Особенности лапароскопических вмешательств у больных с калькулезным холециститом на фоне цирроза печени / Грубник В.В. // Клінічна хірургія. — 2007. — № 1. — С. 16-19.

Даценко Б.М. Обтурационная желтуха — патогенетическая основа развития гнойного холангита и билиарного сепсиса / Даценко Б.М. // Вісник Вінницького національного медичного університету. — 2010. — № 14(1). — С. 15-18.

Транспапиллярные вмешательства у больных с осложненным холедохолитиазом / Дудин А.М., Греджев Ф.А., Коссе Д.М. [и др.] // Мат-ли Всеукраїнської наук.-практ. конференції «Скліфософські читання». — Полтава, 2013. — Т. 13, вип. 1(14). — С. 91-93.

Johansson M. Randomised clinical trial of opean versus laparoscopic cholecystectomy in the treatment of acute cholecystitis / Johansson M., Thune A., Nelvin L. // Br. J. Surg. — 2005. — Vol. 92, № 1. — P.44-49.

A stone extraction facilitation device to achieve an improved technique for performing LCBDE / Wenner D.E., Whitwam P., Rosser J., Hashmi S. // Surg. Endoscopy. — 2005. — Vol. 19. — P. 120-125.




DOI: https://doi.org/10.22141/1997-2938.2.25.2014.83075

Refbacks

  • There are currently no refbacks.


Copyright (c) 2016 UKRAINIAN JOURNAL OF SURGERY

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

 

© Publishing House Zaslavsky, 1997-2017

 

 Яндекс.МетрикаSeo анализ сайта Рейтинг@Mail.ru