Svyrydiuk B. Minimally invasive interventions for acute calculous cholecystitis associated with choledocholithiasis in elderly and senile patients

This dissertation thesis is devoted to solving a problem of the improvement of surgical treatment results in cases of acute cholecystitis associated with choledocholithiasis in elderly and senile patients by developing an optimal treatment and diagnostic algorithm and prioritization of the use of minimally invasive surgical techniques as a method of choice, implementation of the principles of fast-track surgery in the treatment regimen of patients. The dissertation research is based on the analysis of treatment of 259 patients, where control (125 patients) and main (134 patients) groups were formed. The type of surgical intervention depended on the patient's somatic status and the clinical and morphological form of the disease. The treatment and diagnostic algorithm should be individual and has to include the wide use of non-invasive and highly informative examination methods. In order to verify choledocholithiasis and determine the forms of inflammation, anatomical features of the biliary system in elderly and senile patients with acute cholecystitis associated with choledocholithiasis, the application of the magnetic resonance pancreatocholangiography is indicated during the preoperative period, given that the sensitivity and specificity of the method reaches 100 %. The applied algorithm of examination and treatment allowed reducing postoperative mortality rate, the number of postoperative complications, and the length of hospital stay of patients in the main groups. The integration of Fast Track Surgery principles contributes to more effective provision of high-quality surgical care in a high-risk category of surgical patients: pain and dyspeptic syndrome were less manifested and required less time of parenteral drug administration. The use of laparoscopic (endovideoscopic) technologies in the treatment of acute calculous cholecystitis improves the quality of life when evaluated using criteria of the SF-36 questionnaire.