Optimization of cholecystectomy timing during staged treatment of acute cholecystitis in elderly and senile patients with cholecystostomy

Abstract

Aim. To determine optimal timing for laparoscopic cholecystectomy in elderly and senile patients with cholecystostomy.Materials and methods. Treatment results of 37 patients aged 60 years and over at different terms after cholecystostomy formation were analyzed. The degree of senile asthenia, concomitant diseases, technical features of surgical aid, dynamics of the postoperative period, as well as morphological features of inflammatory changes in the gallbladder wall were assessed.Results. Pre-asthenia was detected in 12 (32%) patients, mild senile asthenia – in 14 (38%) patients, and moderate senile asthenia – in 11 (30%) patients. Polymorbidity was determined in all patients, with 23 patients having four or more diseases. In 3 (8%), 15 (40.5%), 15 (40.5%), and 4 (11%) cases, laparoscopic cholecystectomy was performed 3–9 days, 10–30 days, 2–6 months, and 6 months or more (1 conversion) after cholecystostomy.Conclusion. In elderly and senile patients, laparoscopic cholecystectomy performed 10–30 days after cholecystostomy is optimal, safe, and affordable. Radical intervention in this period is not associated with technical difficulties. Reduced terms of external drainage of the gallbladder contribute to improving the elderly patient’s quality of life and their social adaptation, while shortening the period of postoperative recovery. When planning surgical interventions in a patient over 60 years old, account should be taken of comorbidities, polypragmasy, and senile asthenia.