Role and Place of Minimally Invasive Interventions in Treatment of Hepatopancreatoduodenal Diseases in Elderly Patients

Abstract

Aim. To estimate and improve outcomes in elderly patients with hepatopancreatoduodenal diseases. Material and Methods. 221 minimally invasive drainage interventions were performed as the first stage of treatment in 193 patients with obstructive jaundice. At the second stage pancreatoduodenectomy was performed in 4 patients, biliodigestive anastomosis – in 27, percutaneous transhepatic endoprosthesis – in 28, antegrade stenting with nitinol stents – in 12, endoscopic stenting – in 6 cases. After endoscopic lithoextraction cholecystectomy, holedocholitotomy via minimal access was performed in 7 patients, through laparotomy – in 3 cases. Results. There were 72 complications at the first stage of treatment, 44 in percutaneous group and 28 in endoscopic interventions. In group of cancer patients cholangitis was the most common, in case of benign diseases – bleeding from the papilla after papillotomy. 10 (4.8%) deaths were observed after minimally invasive interventions. Total number of deaths – 42 patients (20.3%). Overall incidence of postoperative complications at both stages of treatment in cancer patients was 34.3% (32 patients). Conclusion. Percutaneous and endoscopic methods of biliary tract decompression is effective treatment of obstructive jaundice in elderly patients. Percutaneous transhepatic cholecystostomy is preffered in absence of intrahepatic hypertension. In high risk patients stenting or extrahepatic biliary endoprosthesis are recommended as a final treatment. Percutaneous transhepatic cholangiostomy with stricture recanalization and placement of distal drainage proximal to papilla is indicated to prevent postoperative pancreatitis in case of extrahepatic bile ducts cancer and intact area of papilla. The use of nitinol stents is indicated in patients with neoplastic lesion of middle and proximal third of common bile duct.