Endoscopic and sparing surgical interventions in the treatment of patients with acute cholecystitis and high surgical risk

: Laparoscopic gallbladder drainage was performed as an alternative intervention to an emergency operation in 97 patients with acute cholecystitis whose ages ranged from 60 to 89 years. One patient died from thromboembolism of the pulmonary artery. After acute inflammation was arrested, 37 patients underwent cholecystectomy. The risk of a radical operation was ascertained to be very high in 58 cases. In 19 of these cases endoscopic cleansing of the cystic cavity was performed through cholecystostomy formed during laparoscopic drainage of the gallbladder. In 39 cases the therapeutic process was completed by a sparing operation--sanative cholecystostomy which was carried out under local anesthesia. There were no fatal outcomes in these groups. Endoscopic papillosphincterotomy was conducted in 17 patients, with stones in the gallbladder and choledocholithiasis, after which the stones were removed. The performance of endoscopic and surgical interventions which cause minimal injury provides for adequate sanative treatment of the gallbladder in cases in which cholecystectomy is an extremely high risk.