Improvement of Tactical and Technical Approaches to Surgical Treatment of Elderly and Senile Patients With Complicated Forms of Cholelithiasis

The results of treatment of 171 elderly and senile patients with complicated forms of GI are presented. Factor analysis revealed that the highest percentage of mortality, purulent-septic and extra-abdominal complications (14.8%, 48.1% and 55.6%, respectively) in elderly and senile patients was observed after attempts of simultaneous radical surgical correction of acute destructive cholecystitis or obstructive cholangitis. Stage-by-stage surgical treatment, taking into account the developed criteria for assessing the severity of the patient's condition and the predicted risk of postoperative complications, using preliminary minimally invasive decompression interventions on the bile ducts performed in 42.2% of patients in the main group, allowed to stop purulent-cholemic intoxication and improve the results of subsequent radical operations. In 15.6% of patients, these interventions were the final method of treatment. Optimization of the tactical and technical aspects of surgical treatment of elderly and senile patients with complicated forms of GI, taking into account the severity of the patient's condition and the predicted risk of postoperative complications, significantly reduced mortality, postoperative purulent-septic and extra-abdominal complications (3.1%, 12.4% and 29.9%, respectively), while in the comparison group these indicators were 8.1% , 32.4% and 41.9%.