Minimally invasive technologies for treatment of gallstone disease complicated by mechanical jaundice in patients of elderly and senior age
- Authors: Zarkua N.E.1, Krivov A.P.1, Akimov V.P.1, Lysenkov S.Y.1
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Affiliations:
- North-Western State Medical University named after I.I. Mechnikov
- Issue: Vol 14, No 4 (2022)
- Pages: 63-70
- Section: Original research
- URL: https://journals.eco-vector.com/vszgmu/article/view/112556
- DOI: https://doi.org/10.17816/mechnikov112556
- ID: 112556
Cite item
Abstract
BACKGROUND: In recent years, there has been a significant increase in the number of patients of older age groups with cholelithiasis and its complications. Trans-light endoscopic and hybrid technologies for the treatment of cholelithiasis complicated by mechanical jaundice in such patients can reduce the proportion of traditional operations, the frequency of complications and mortality.
AIM: To develop an algorithm for the treatment of cholelithiasis complicated by mechanical jaundice in elderly and senile patients based on the use of modern minimally invasive and hybrid technologies.
MATERIALS AND METHODS: The analysis of the treatment of 116 elderly and senile patients with cholelithiasis complicated by mechanical jaundice from 2016 to 2021 has been carried out.
RESULTS: After a comprehensive examination of patients, the following pathology has been diagnosed: choledocholithiasis (cholecystectomy in the anamnesis) — in 7.8%; сholedocholithiasis (cholecystectomy in the anamnesis) + stricture of the distal choledochus — in 9.5%; сholecystocholedocholithiasis — in 82.7%, including choledocholithiasis without major duodenal papilla stricture in 7.3%, Mirizzi syndrome (including major duodenal papilla stenosis — in 3.1%) — in 5.2%, choledocholithiasis + stricture of the distal choledochus in 79.2% and choledocholithiasis + stricture of the distal choledochus + parafaterial diverticulum in 8.3% of the patients. The severity of the comorbidity index according to the Kaplan – Feinstein scale in 2.6% of patients corresponded to a mild degree, in 70.7% — to a moderate degree, in 26.7% — to a severe degree. Trans-luminous endoscopic and hybrid technologies have been used to eliminate the stricture of the distal part of the bile duct and sanitation of the bile ducts. Traditional operations by endovideosurgical and mini-access as well as laparotomy have been performed in 5.2%, 13.8% and 2.6% of the patients, respectively. The mortality rate was 3.5%. Complications associated with endoscopic interventions have developed in 5 (4.3%) patients, including — retrograde cholangiopancreatography-induced pancreatitis — in 2, bleeding from the incision of the duodenal papilla — in 3 patients.
CONCLUSIONS: Trans-light endoscopic and hybrid technologies for the treatment of cholelithiasis complicated by mechanical jaundice in patients with severe comorbidity index can reduce the proportion of traditional operations, the frequency of complications and mortality.
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About the authors
Nonna E. Zarkua
North-Western State Medical University named after I.I. Mechnikov
Email: tatazarkua@mail.ru
ORCID iD: 0000-0002-7457-3149
SPIN-code: 4568-4125
MD, Dr. Sci. (Med.), Professor
Russian Federation, Saint PetersburgAlexandr P. Krivov
North-Western State Medical University named after I.I. Mechnikov
Email: alexander_krivov_1386@mail.ru
ORCID iD: 0000-0002-8981-3803
SPIN-code: 8287-3558
Russian Federation, Saint Petersburg
Vladimir P. Akimov
North-Western State Medical University named after I.I. Mechnikov
Email: akimov.spbmapo@mail.ru
ORCID iD: 0000-0002-7388-0366
MD, Dr. Sci. (Med.), Professor
Russian Federation, Saint PetersburgSergey Yu. Lysenkov
North-Western State Medical University named after I.I. Mechnikov
Author for correspondence.
Email: sfc.onetwo@gmail.com
ORCID iD: 0000-0003-1542-1863
MD
Russian Federation, Saint PetersburgReferences
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