Minimally invasive technologies for treatment of gallstone disease complicated by mechanical jaundice in patients of elderly and senior age

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.