[Features of surgical strategy in acute cholecystitis in old patients]

Results of treatment of 197 patients at the age of 75-years and older with acute cholecystitis in terms of active (early operations) and active-delaying (delayed and elective operations) policy were analyzed. It was established that changes of gall bladder wall in old patients with acute cholecystitis are of ischemic genesis, of primary-destructive and irreversible nature leading to gangrene and phlegmon of gall bladder wall in 84% cases. In 2/3 cases clinical picture doesn't reflect destructive nature of the disease. Severity of the patients state and its dynamics may be assessed most objectively by APACHE III. Conservative treatment doesn't prevent progress of destructive-inflammatory process and complications development. Cholecystectomy from laparotomy is the operation of choice in this group of patients. Early radical operation for acute cholecystitis in old patients permits to decrease postoperative lethality to 3.3%. The score of APACHE III at hospitalization is the criterion of the scope and terms of surgery. If APACHE III is more than 55 points, it is necessary to carry out complex preoperative correction of somatic disorders. Minimally invasive palliative operations are indicated for 10% patients of this category.