THE CHOICE OF ACCESS FOR CHOLECYSTECTOMY IN PATIENTS OF OLD AGE

R.T.MAJIDOV, K.M.KURBANOV, R.R.KURBANISMAILOVA, M.D.MAJIDOV

Dagestan State Medical Academy; Makhachkala, RUSSIA

The work includes comparative analysis of three accesses to cholecystectomy. Laparoscopic cholecystectomy (LCE) - 44, cholecystectomy from mini-access (MLD) - 42, traditional cholecystectomy (TCE) - 45. Complications in LCE were observed in 7 (16.1%), MLD – in 2 (4.7%), TCE - in 12 (26.6%) patients.

The aim of the study. To improve the results of surgical treatment of patients of old age c cholelithiasis and its complications by the seection of surgical approach.

Materials and methods. Over the last 3 years, 131 patients of old age (75 years and above) with cholelithiasis and its complications were performed cholecystectomy at general surgery clinic of Dagestan state medical academy. LCE was performed in 44 patients, cholecystectomy from MLD – in 42, TCE - in 45.

Results and discussions. Comparative analysis of cholecystectomy from three accesses showed that many intra-and postoperative complications are characteristic for both mini-invasive operations and surgical procedures performed from a wide laparotomy. Among the 7 (16.1%) complications, observed in LCE, intraoperative complications were observed in 2 (4.6%) patients, postoperative - in 5 (11.5%). When using MLD, complications during the operation were observed in 2 (4.7%) patients, early postoperative - in 3 (7.0%). In case of TCE, the total number of complications constituted 26.6% (12 cases). Of them, intra-operative complications were observed in 3 (6.6%) operated, and post-operative - in 9 (20.0%).

Local intra-operative complications in the analyzed groups of patients were encountered equally often and constituted - 4.8% in case of LCE, 4.9% in case of MLD and - 5.0% in case of TCE. Common complications we observed by us during LCE in 1.7% of patients, during MLD and TCE the figure constituted 0.9% and 1.8% respectively in each group.

The largest number of postoperative complications were observed in patients which underwent surgical intervention by wide laparotomy - 16.8%, during LCE the figure consituted 11.9% and MLD - 6.9%. Patients who underwent TCE, had higher percentage of overall postoperative complications - 8.3% vs 3.2% during LCE and 1.8% - during MLD. Late postoperative complications occurred in 3.4% of patients operated by a traditional method and only in 0.8% - after the LCE, and after

Date: 2014-12-28; view: 913