[Surgical approach for destructive cholecystitis in elderly and old patients]

The individual surgical policy in the treatment of patients over 60 years of age with destructive cholecystitis was developed. Urgent radical surgical procedures using total intravenous anesthesia with endotracheal intubation and ALV were performed in patients with a low surgical and anesthetic risk and without concomitant acute pancreatitis and obstructive jaundice. Cholecystostomy and delayed cholecystectomy were performed in patients with these concomitant pathologies. Palliative operations were performed in patients with high surgical and anesthetic risk. Patients with disseminated peritonitis underwent cholecystectomy through laparotomy using total intravenous anesthesia with epidural blockade. Choice of method of cholecystectomy and anesthetic management depended on nature of concomitant diseases and complications. Proposed individual surgical policy permitted to decrease postoperative lethality to 0.8%.