Диференційований підхід до вибору методу лікування ускладненої жовчнокам'яної хвороби у пацієнтів старшої вікової групи

Results of 208 patients surgical treatment of elder and senile age with different forms of acute calculous cholecystitis, choledocholithiasis and its complications in the period from 2007 to 2016 were analyzed. Obstructive jaundice due to choledocholithiasis and severe comorbidity were present in all of the patients. The study showed that surgical tactics in patients of this group should be based on a comprehensive analysis of clinical and instrumental examination data. Method of choice in patients with acute cholecystitis, large, multiple and impacted common bile duct calculi is traditional open cholecystectomy, choledocholithotomy. In other cases, undoubted advantage has the laparoscopic cholecystectomy combined with laparoscopic and endoscopic retrograde papillotomic choledocholithoextraction performed during pre-, intra- and post-operative period. In the treatment of patients with severe systemic diseases, especially of the cardiovascular and respiratory systems, preference should be given to videoendoscopic "gasless" mode. The proposed differentiated approach can significantly improve the results of treatment of patients in this group.