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[Surgical management of acute cholecystitis in elderly and old age patients]
Insights
Percutaneous transhepatic gallbladder drainage (PTDGB) effectively manages acute cholecystitis in elderly patients, improving their condition for subsequent treatment. This approach reduced the need for immediate surgery in many cases.
Area of Science:
- Gastroenterology
- Hepatobiliary Surgery
- Geriatric Medicine
Background:
- Acute cholecystitis presents significant challenges in elderly patients.
- High morbidity and mortality rates are associated with delayed or aggressive treatment in this population.
Purpose of the Study:
- To analyze the treatment outcomes of acute cholecystitis in 233 elderly patients.
- To evaluate the effectiveness of minimally invasive procedures in managing acute cholecystitis and improving patient condition.
Main Methods:
- Percutaneous transhepatic gallbladder drainage (PTDGB) under ultrasound (US) control was performed in 206 patients.
- Laparoscopic cholecystostomy in 2 patients and early endoscopic papillosphincterotomy in 27 patients with choledocholithiasis and jaundice.
- Early surgical intervention (cholecystectomy) was performed in 189 patients within 2-4 days of admission.
Main Results:
- PTDGB and endoscopic papillosphincterotomy successfully eliminated acute attacks in 44 patients, avoiding immediate surgery.
- Early intervention improved patient condition, allowing for further examination and management of comorbidities.
- The overall postoperative mortality rate was 4.2%.
Conclusions:
- Minimally invasive decompression techniques like PTDGB are crucial for stabilizing elderly patients with acute cholecystitis.
- Early decompression facilitates subsequent management, including elective surgery, and improves outcomes.
- A staged approach involving initial decompression followed by definitive treatment is effective in this high-risk group.
Abstract:
Results of treatment of 233 old and elderly patients with acute cholecystitis were analysed. In 206 from them percutaneous transhepatic drainage of the gallbladder (PTDGB) was carried out under US control with creation of temporary microcholecystostoma for elimination of acute attack of cholecystitis by decompression of the biliary system, in 2 patients laparoscopic cholecystostomy was performed, and in 27 patients with choledocholithiasis and jaundice early endoscopic papillosphincterotomy was carried out. Elimination of acute attack of cholecystitis in early terms contributed much to improvement of the patients condition, to carrying out further examination and correction of concomitant diseases. After adequate premedication 189 patients were operated on early after admission (on day 2-4). The operation of choice was cholecystectomy, in 49 patients being combined with various interventions on the choledochus. Postoperative mortality rate made up 4.2%. 44 patients were not operated because of elimination of the attack by PTDGB (17) and endoscopic papillosphincterotomy (27).