[Surgical interventions on the gallbladder and the biliary tract in the aged]

The surgery of the gall bladder by gallstones, bile duct and alterations of the duodenal papilla are conducted with an increase of lethality. This increased lethality is caused by accompanying ill effects, especially chronical pancreatitis, cholangitis, disturbances of the liver. The indications to operate old patients are occlusions of duodenal papilla relapsing colics with or less occlusing icterus, emphysema of gall bladder or perforation. A careful narcosis is necessary by disease of circulation, diabetes, bronchitis and emphysema of the lung. Simple cholestectomies in old patients have a mortality of 0-1%. Interventions on bile ducts, transduodenal papillotomia, choledochoduodenotomy have an mortality of 4-8%. The intraoperative cholangiography is always necessary. Operations on bile duct are finished by inserting a T-drain. The distal portion of the T-drain are not emissed through the duodenal papilla, because a pancreatitis can be released. The principal postoperative complication is the pancreatitis, consumption coagulopathy, bronchopneumonia, cholangitis with intermitting fever and injuries of the liver parenchym. The persisting pancreatitis can be treated with infusions.