[Diagnosis and surgical treatment of acute destructive calculous cholecystitis in advanced age patients].

Objective: To develop an algorithm for surgical treatment of acute destructive cholecystitis in elderly and senile patients and to improve postoperative outcomes in this cohort of patients.

Material And Methods: A prospective analysis included 50 patients with acute destructive cholecystitis aged 60-90 years, who admitted to the Topchubashov Research Surgical Center for the period from 2015 to 2019. All patients had diabetes mellitus, obesity or cardiovascular diseases. Ultrasound was performed in all patients, CT - in 60% of patients, MRI - in 36% of cases. Thirty-six (72%) patients underwent laparoscopic cholecystectomy, 14 (28%) patients - open cholecystectomy.

Results: Intra- and postoperative complications were analyzed in both groups. In our opinion, subtotal 'fundus first' cholecystectomy should be preferred for safe cholecystectomy and prevention of iatrogenic lesions. Laparoscopic 'fundus first' cholecystectomy was carried out in 16% of patients (including 10% of subtotal cholecystectomies). Pribram subtotal cholecystectomy was performed in 5 (10%) patients. Iatrogenic damage to the common bile duct was absent.

Conclusion: We have developed an algorithm for the diagnosis and surgical treatment of acute destructive calculous cholecystitis in advanced age patients.