[Problems in the surgical treatment of calculous cholecystitis]

Abstract

The article analyses experience of the N. N. Burdenko clinic in surgical treatment of cholelithiasis. A total of 4,733 operations for cholecystectomy were performed. 96.7% of them were of a planned order, 14.3% of patients who underwent operation 65 years of age and older. Cholecystectomy was expanded to choledocholithotomy in 2.7, papillosphincterotomy in 1.7, separation of biliodigestive fistules in 0.6% of cases. Various combined operations were carried out on 558 patients. Intraoperative complications developed in 0.96% of cases: damage to the hepaticocholedochus (0.14%) and to the hepatic artery proper (0.02%) and its right branch (0.02%). Relaparotomy was performed in 0.86% of cases: for bile leakage (0.54%) and for bleeding (0.15%). Suppuration occurred in 3.9% of patients who were operated on. Total mortality was 0.25% (0.09% after planned and 5.7% after emergency operations). Fatal complications were encountered in 0.1% of patients under 65 years of age and in 1.18% of older patients. Fatal outcomes occurred in 1.1% of 558 combined operations, one of which was cholecystectomy; in none of the cases could the fatal complication be connected with expansion of the intervention. As it can be seen from the above-discussed material, there are definite prospects for improving the results of cholecystectomy: an obligatory condition is conduction of the operation in a planned order and under 65 years of age. Careful assessment of the operative risk factors for each patients on the basis of modern mathematical methods will help in solving the problem of the possibility of surgical treatment.(ABSTRACT TRUNCATED AT 250 WORDS)