Features of acute cholecystitis treatment in elderly and senile patients

  • Received 19.06.2021

  • Revised 27.07.2021

  • Accepted 30.08.2021



  • 1,012 Views

  • Retrieved from Volume 3, No. 3, 2021

  • Pages 101-107

Summary. Acute cholecystitis is the most common urgent abdominal pathology. Cholelithiasis is the cause of the disease in most cases. Approximately half of the patients with acute cholecystitis are elderly and senile. The use of minimally invasive technologies allows performing an adequate amount of surgical intervention with minimal trauma of the operation. The aim of the study – to consider scientific approaches to solving the question of the tactics of surgical intervention in acute cholecystitis in elderly and senile patients. Materials and Methods. The databases Pubmed, medLine, EmBASE, CINAHL, PsycINFO were used, the search included publications until 2020. The studies met the following criterion: studies aimed at identifying the tactics of surgical intervention in acute cholecystitis in elderly and senile patients. Results. The results of recent studies allow us to better understand the tactics of surgical intervention in acute cholecystitis in elderly and senile patients, and also open the way for further research. The most common factors limiting active surgical tactics are the presence of several pathologies in gerontological patients at the same time, as well as late hospitalization. The use of conservative therapy in order to eliminate the inflammatory process and stabilize the concomitant pathology is not always effective, it leads to forced operations against the background of complications and decompensation of systemic diseases. The emergence of new diagnostic and minimally invasive treatment technologies has made it possible to introduce active surgical tactics with short preoperative conservative preparation in gerontological patients. Conclusions. Performing traditional cholecystectomy in patients with acute cholecystitis is associated with a high surgical and anesthetic risk and mortality rates. The use of minimally invasive methods of treatment can reduce the degree of intraoperative and postoperative risk. Taking into account the high level of mortality and frequent complications this direction requires a further study

cholelithiasis, acute cholecystitis, elderly and senile patients, traditional cholecystectomy, minimally invasive surgical intervention technologies

https://doi.org/10.11603/bmbr.2706-6290.2021.3.12447

[1] Carey LC. Cholecystectomya new standard. Ann Surg. 2019;309(6):  619.  DOI:  10.1097/00000658-199212000-00001.

[2] Festi D, Dormi A, Capodicasa S, Staniscia T, Attili AF, Loria P, Colecchia A. Incidence of gallstone disease in Italy: results from a multicenter, population–based Italian study (the MICOL project). World J Gastroenterol. 2008;14(34): 5282-9. DOI: 10.3748/wjg.14.5282

[3] Ha A, Richards C, Criman E, Piaggione J, Yheulon C, Lim R. The safe use of surgical energy devices by surgeons may be overestimated. Surg. Endosc. 2018;32(9): 3861-7. DOI: 10.1007/s00464-018-6116-1.

[4] Sartelli  M,  Chichom-Mefire  A,  Labricciosa  FM, Hardcastle T, Abu-Zidan FM, Adesunkanmi AK, Catena F. The  management  of  intra-abdominal  infections  from  a global perspective: 2017 WSES guidelines for management of intra-abdominal infections. World J Emerg Surg. 2017;12: 29. DOI: 10.1186/s13017-017-0141-6.

[5] Watanabe Y, Kurashima Y, Madani A, Feldman LS, Ishida M, Oshita A, Hirano S. Surgeons have knowledge gaps  in  the  safe  use  of  energy  devices:  a  multicenter cross-sectional  study.  Surg  Endosc.  2016;30(2):  588-92. DOI: 10.1007/s00464-015-4243-5.

[6] Polo M, Duclos A, Polazzi S, Payet C, Lifante JC, Cotte  E,  Passot  G.  Acute  cholecystitis  –  optimal  timing for  early  cholecystectomy:  a  french  nationwide  study.. Gastrointest.  Surg.  2016;19(11):  2003-10.  DOI:  10.1007/s11605-015-2909-x.

[7] Halldestam  I,  Enell  EL,  Kullman  E,  &  Borch  K. Development  of  symptoms  in  individuals  with  gallstones. Br J Surg. 2004;91(6): 734-8. DOI: https://doi.org/10.1002/bjs.4547.

[8] Hodlevskyi  AI,  Savoliuk  SI,  Yarmak  OA.  [Surgical treatment  of  cholelithiasis:  unshakable  principles,  gentle technologies]. Khirurhiia Ukrainy. 2011;1: 45-9. Ukrainian.

[9] Lupaltsov VI, Lesovoy VN Emergency surgery of the abdominal  and  retroperitoneal  organs.  [Неотложная  хирургия органов брюшной полости и забрюшинного про-странства] Kharkiv: Kontrast; 2014. Russian.

[10] Wakabayashi  G.,  Iwashita  Y,  Hibi  T,  Takada  T, Strasberg SM, Asbun HJ, Yamamoto M. Tokyo Guidelines 2018:  surgical  management  of  acute  cholecystitis:  safe steps in laparoscopic cholecystectomy for acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci. 2018;25(1): 73-86. DOI: 10.1002/jhbp.517.

[11] Kohga A, Suzuki K, Okumura T, Yamashita K, Isogaki J, Kawabe A, Kimura T. Outcomes of early versus delayed laparoscopic  cholecystectomy  for  acute  cholecystitis performed  at  a  single  institution.  Asian  J  Endosc  Surg. 2018;13(8): 551-8. DOI: 10.1111/ases.12487.

[12] Muntian S [Pathogenetic mechanisms of origin and development  of  gallstone  disease].  Shpytalna  khirurhiia. 2003;1: 81-4. Ukrainian.

[13] Saber  A,  Hokkam  EN.  Operative  outcome  and patient  satisfaction  in  early  and  delayed  laparoscopic cholecystectomy.  Minim  Invasive  Surg.  2014;162:  643. DOI: 10.1155/2014/162643.

[14] Tsuyuguchi  T.,  Takada  T,  Kawarada  Y,  Nimura  Y, Wada  K,  Nagino  M,  Dervenis  C.  Techniques  of  biliary drainage  for  acute  cholecystitis:  Tokyo  Guidelines. J  Hepatobiliary  Pancreat  Surg.  2007;14(1):  46-51. DOI: 10.1007/s00534-006-1155-8.

[15] Yanni F, Mekhail P, Morris-Stiff G. A selective antibiotic prophylaxis policy for laparoscopic cholecystectomy. Ann R Coll Surg Engl. 2013;95(5): 345-8. DOI: 10.1308/003588413X13629960045959.

[16] Panni  RZ,  Strasberg  SM.  Preoperative  predictors of conversion as indicators of local inflammation in acute cholecystitis:  strategies  for  future  studies  to  develop quantitative  predictors.  J  Hepatobiliary  Pancreat  Sci. 2018;25(1): 101-8. DOI: 10.1002/jhbp.493.

[17] Song X, HuY, Li Y, Shao R, Liu F, Liu Y. Overview of  current  targeted  therapy  in  gallbladder  cancer.  Signal Transduct  Target  Ther.  2020;5(1):  230.  DOI:  10.1038/s41392-020-00324-2.

[18] Letelier  P,  Garcia  P,  Leal  P,  Ili  C,  Buchegger  K, Riquelme I, Roa JC. Immunohistochemical expression of vascular endothelial growth factor A in advanced gallbladder carcinoma. Appl. Immunohistochem   Mol   Morphol. 2014;22(7): 530-6. DOI: 10.1097/PAI.0b013e3182a318a9.

[19] Park  SY,  Chung  JS,  Kim  SH,  Kim  YW,  Ryu  H, Kim  DH.  The  safety  and  prognostic  factors  for  mortality in  extremely  elderly  patients  undergoing  an  emergency operation.  Surg  Today.  2015;46(2):  241-7.  DOI:  10.1007/s00595-015-1147-x.

[20] Vetshev  PS,  Shulutko AM,  Prudkov  MI.  [Surgical treatment of cholelithiasis: unshakable principles, sparing technologies]. Khirurgiia. 2016;8: 12-9. Russian.

[21] Sapalidis K, Kosmidis C, Michalopoulos N, Laskou S, Pavlidis E, Mantalovas S, Kesisoglou I. Mini-laparoscopic cholecystectomy  with  the  MiniLap  percutaneous  surgical system: a series of 32 patients. Int J General Med. 2018; 369-71. DOI: 10.2147/IJGM.S172655.