Abstract:

Aim: was to investigate the application of decompression interventions conducted under ultrasound control in patients with acute cholecystitis in elderly including methods of obliteration of gallbladder with «MM-ge».

Materials and methods. For the period from July 2008 to September 2011 in City Hospital №68 mini-invasive methods have been appliec in 173 elderly and senile age patients with clinical and echographic picture of acute destructive cholecystitis. There were performed 219 minimally invasive procedures. In this study we performed obliteration of the gall bladder through the implantation of a porous crosslinked polyvinyl alcohol («MM-gel»), intended for use in medicine.

Results. On the base of experience we developed tactics of treatment of elderly and senile patients with acute cholecystitis with the use of mini-invasive ultrasound-guided interventions. Study showed that it is optimum to make gallbladder puncture under ultrasound guidance for sanitation and decompression. In case of failure percutaneous ultrasound-cholecystostomies were performed. Obliteration of gallbladder cavity with implantation of «MM-gel» were successfully performed in 5 cases.

Conclusions. During the research, efficiency and safety of minimally invasive treatment of acute cholecystitis in elderly and senile patients were proved, there was no negative impact on quality of life. Obliteration of the gallbladder cavity with plastic «MM-gel» can be the method of choice for surgical treatment of these patients and requires further development and study of long-term results.

References

1.     Vasiliev V.V.,Perunov A.B. Acute colecystitis: modern technologies of treatment. Consilium Medicum. 2001; 6: 279-284 [In Russ].

2.     Gallinger Yu.I., Karpenko V.I.,Mizikov V.N. Laparoscopic cholecystectomy in patients with high operational-anestesialogical risk. Annals of Surgical Hepatology. 2002;1: 97 [In Russ].

3.     Ermolov A.S., Gulyaev A. A., Acute cholecystitis : modern methods of treatment. Treating physician. 2005; 2: 16-18 [In Russ].

4.     Ermolov. S. Ivanov, P. A., Turco A.P.. The main causes of mortality in acute cholecystitis in a hospital in Moscow. Proceedings of the urban scientific conference. M. 1999: 5-11 [In Russ].

5.     Kapralov S.V., Ismailov U.Z., Shapkin J.G. The role and place diapevticheskih decompression operations in the surgery of acute cholecystitis in patients with high-risk surgery and anesthesia. Modern problems of science and education. 2010;2: 47-52 [In Russ].

6.     Privalov V. A., Shramchenko V.A., Gubnitsky A .V. Surgical tactics in acute cholecystitis in elderly patients and old age. Surgery. 1998; 7: 28 - 30 [In Russ].

7.     Altmeir G., Die akute Cholecystitis. G. Altmeir. Chirurg. 2001; 3(52): 450-453.

8.     Zatevakhin 1.1., Tsitsiashvili M.S., Dzarasova G.J. Acute cholecystitis : diagnosis and treatment. Journal of MedicalUniversity. 2000; 3: 21-26 [In Russ].

9.     9. Pantsirev J.M., Nozdrachev V.I., Lagunchik B.P. Decompression of the gallbladder in acute cholecystitis in elderly patients and old age. Surgery. 1990; 2: 17-20 [In Russ].

10.   Tagiyeva M.M. Diagnosis and treatment of acute cholecystitis. Surgery. 1998; 1:15-19 [In Russ].

11.   Fedorov V.D., Danilov M.V., Glabay V.P. Emergency surgery of cholelithiasis. In book Cholecystitis and its complications. Cholecystitis and its complications. Bukhara. 1997: 28-29 [In Russ].

12.   Shulutko A.M. ,Lukomski G.I.,Surin Y.V. Predicting the risk of surgery in acute cholecystitis. Surgery. 1989; 1: 29-32 [In Russ].

13.   Kuznetsov N.A., Ignatenko S.N., Brontveyn A.T., Rodoman G.V. Modern technologies of treatment of acute cholecystitis . Actual problems of practical medicine : Sat. researcher. Tr./ MoscowStateMedicalUniversity. 2000: 77-87 [In Russ].

14.   Zhidkov S.A. Clinical management of acute cholecystitis in patients over 60 years. Medical News. 2005; 7: 68-70 [In Russ].

15.   Zatevakhin I.I. , Magomedov E.G. Therapeutic tactics in acute cholecystitis. Russian Journal of Medicine. 2005; 4: 17-20 [In Russ].

16.   Kuznetsov N.A., Brontveyn A. T., Aronov L.S. Laparoscopic cholecystectomy in acute cholecystitis. Russian Journal of Medicine. 2003; 3: 19-22 [In Russ].

17.   Korovin A.J., Andreev A.V., Kulish V.A., Meshesha Berhane Reda. Ultrasonography in the diagnosis and evaluation of the effectiveness of percutaneous decompression of the gallbladder in patients with acute cholecystitis. In Sat: New Technologies in Medicine (morphological, experimental, clinical and social aspects). Volgograd: Print. 2005: 182-183 [In Russ].

18.   Chadayev A.P., Lyubsky A.S. Two-stage treatment of acute cholecystitis in elderly patients. Int. researcher. conference.: «Actual issues of diagnosis and treatment of diseases of the hepatobiliary area. Endoscopic Surgery.» Proc. Reports. St. Petersburg. 1996: 162-163 [In Russ].

19.   Ichikawa M., Takahara О., Ishihara A. et al. Percutaneous transhepatic ultrasound-guided puncture of the gallbladder for acute cholecystitis. Brit. Med. J. 1996; 8: 8-16.

20.   Gulyaev A.A., Shapovalyants S.G., Burov V.A., Mihaylusov S.V. Obliteration of the lumen of the gallbladder in patients with high operative risk. Surgery. 1998; 9: 42-44 [In Russ].

21.   Emelianov S.I., Fedorov A.V., Fedenko V.V. Technological aspects of endoscopic surgery of the billiary tract. Annals of Surgical Hepatology. 1996; 1: 115-119 [In Russ].

22.   Nikulenkov S. Yu., Belkov A.V., Efimkin A.C. Endoscopic obliteration of the gallbladder in patients with acute cholecystitis with high operativ risk. Endoscopic Surgery. 1998; 1: 34 [In Russ].

Abstract:

Aim: was to estimate the expediency of one-time sanation of the gallbladder, performed under ultrasound control in patients with acute cholecystitis as a preoperative preparation.

Material and methods. For the period 2007-2016, 1365 sanations of the gallbladder were performed in 1289 patients with acute cholecystitis. In 1284 cases (94.1%), the manipulation was single-staged, performed under local anesthesia by echo-puncture needles, caliber of 17.5 G under ultrasound control by the "free hand" method or using a program of biopsy cursor, percutaneously transhepatic. Access was made through the hepatic parenchyma with a thickness of at least 10 mm. Results. Sanation of the gallbladder was effective in all 1365 cases. Repeated sanitation in a day was necessary in 76 patients. Cholecystectomy within the current hospitalization was performed ir 1132 of (87.8%) 1289 patients, in terms from 1 to 4 days after initial manipulation. The dislocation of the blocking gall-stone from the cervical region of the gallbladder into its lumen was made with a rigid 0.035" gidewire in order to restore cystic duct flow was effective in 122 cases (35.2%). Complications: subcapsular hematomas of the liver in the puncture zone - 4 (0.3%), bilomus of the gallbladder bed - 1 (0.07%), bleeding to the gallbladder lumen - 11 (0.8%) were treated conservatively. There were no lethal outcomes.

Conclusion: one-time sanation of gallbladder allows to decompress safely the gallbladder, to stop pain syndrome, to conduct a full pre-examination and preoperative preparation of patient and perform cholecystectomy in the most comfortable and safe conditions in a delayed or planned order. 

References

1.     Buyanov V.M., Ishutinov V.D., Zinyakova M.V., Titkova I.M. Ultrazvukovaya klassifikatsia ostrogo holetsistita. [Ultrasound classification of acute cholecystitis.] Vserossijskaja konferencija hirurgov: Tezisy dokladov. [Proc. Conf. Surgeons: All-Russian conference of surgeons: Tez. dokl]. Yessentuki. 1994; 51-52 [In Russ].

2.     Takada T., Strasberg S.M., Solomkin J.S., Pitt H.A., Gomi H., Yoshida M., Mayumi T., Miura F., Gouma D.J., Garden O.J., Bьchler M.W., Kiriyama S., Yokoe M., Kimura Y, Tsuyuguchi T., Itoi T., Gabata T., Higuchi R., Okamoto K., Hata J., Murata A., Kusachi S., Windsor J.A., Supe A.N., Lee S., Chen X.P., Yamashita Y, Hirata K., Inui K., Sumiyama Y Tokyo Guidelines Revision Committee. TG13: Updated Tokyo Guidelines for the management of acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci. 2013; 20(1): 1 -7. doi: 10.1007/s00534-012-0566-y. PMID: 23307006.

3.     Yokoe M., Takada T., Strasberg S.M., Solomkin J.S., Mayumi T., Gomi H., Pitt H.A., Garden O.J., Kiriyama S., Hata J., Gabata T., Yoshida M., Miura F., Okamoto K., Tsuyuguchi T., Itoi T., Yamashita Y, Dervenis C., Chan A.C., Lau W.Y, Supe A.N., Belli G., Hilvano S.C., Liau K.H., Kim M.H., Kim S.W., Ker C.G. Tokyo Guidelines Revision Committee. TG13 diagnostic criteria and severity grading of acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci. 2013; 20(1):35-46. doi: 10.1007/s00534-012-0568-9. PMID: 23340953.

4.     Kimura Y, Takada T., Strasberg S.M., Pitt H.A., Gouma D.J., Garden O.J., Bьchler M.W., Windsor J.A., Mayumi T., Yoshida M., Miura F., Higuchi R., Gabata T., Hata J., Gomi H., Dervenis C., Lau W.Y, Belli G., Kim M.H., Hilvano S.C., Yamashita Y TG13 current terminology, etiology, and epidemiology of acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci. 2013; 20( 1 ):8-23. doi: 10.1007/s00534-012-0564-0. PMID: 23307004.

5.     Mayumi T., Someya K., Ootubo H., Takama T., Kido T., Kamezaki F., Yoshida M., Takada T. Progression of Tokyo Guidelines and Japanese Guidelines for management of acute cholangitis and cholecystitis. J UOEH. 2013; 35(4):249-57. PMID: 24334691.

6.     Briskin B.S., Minasyan A.M., Vasilieva М.А., Barsukov M.G. Chreskozhnaja chrespechenochnaja mikroholecistostomija v lechenii ostrogo holecistita. [Percutaneous transhepatic microcholecystostomy in acute cholecystitis treatment]. Annaly khirurgicheskoy gepatologii. 1996; 1(1):98-107 [In Russ].

7.     Ivanov S. V., Okhotnikov O.

Abstract:

Currently, the combination of acute cholecystitis complicated by choledocholithiasis is quite common.

Aim: was to improve the efficiency of diagnosis of complicated forms of gallstone disease (acute cholecystitis complicated by choledocholithiasis).

Materials and methods: study included 118 patients with acute cholecystitis complicated by choledocholithiasis. The age of patients ranged from 16 to 92 years (mean age 61,5 ± 2,5 years). Women were 86(78.5%), men - 32 (21.5%). All patients underwent ultrasound examination of the abdominal cavity, hepatobiliary scintigraphy (HBSG), MRI-cholangiography (MRHG), endoscopic retrograde cholangiopancreatography (ERCP) and biochemical blood tests with determination of total bilirubin, amylase, alanine aminotransferase (ALT) and aspartate aminotransferase (AST), alkaline phosphatase (ALP), total protein and protein fractions.

Results: in the diagnosis of choledocholithiasis sensitivity of ultrasound was 86%; HBSG - 97% MRHG - 92%. Basing on these data of sensitivity of different diagnostic methods, we developed diagnostic algorithm of acute cholecystitis complicated by choledocholithiasis: US → HBSG (if inefficient US ir terms of visualization of the distal common bile duct) → MRHG (to clarify causes of focal disorders of transport of labeled bile, according to HBSG) → ERCP: endoscopic papillosphincterotomy (EPST) and lithoextraction (LE) (detected choledocholithiasis or lingering doubts in the diagnosis).

Conclusions: the use of the diagnostic algorithm for acute cholecystitis in many cases allows timely identification of choledocholithiasis, followed by the implementation of adequate endoscopic sanitation of biliary tract, before performing cholecystectomy . 

References

1.     Savel'ev B.C. Endoskopicheskie metody issledovaniya v diagnostike porazheniy vnepechenochnykh zhelchnykh protokov pri kal'kuleznom kholetsistite [Endoscopic techniques in the diagnosis of lesions of extrahepatic bile ducts in the calculous cholecystitis]. In: B.C. Savel'ev, M.I. Filimonov, A.S. Balalykin. Problemy khirurgii zhelchnykh putey [Problems of biliary tract surgery]. Moscow. 1982; 168-169 [In Russ].

2.    Gal'perin E.I. i Vetshev P.S. Rukovodstvo po khirurgii zhelchnykh putej [Guide for surgery of the biliary tract ]. M: Vidar. 2009; 568 S [In Russ].

3.     Аrdasenov T.B., Frejdovich DA., Pan'kov А.G., Brudzinskij SA., Orlova E.N. Dooperatsionnaya diagnostika skrytogo kholedokholitiaza [Preoperative diagnosis of latent choledocholithiasis]. Апп khir. gepatol. 2011; 2: 18-24 [In Russ].

4.    Dadvani S.А., Vetshev P.S., SHulutko АЖ., Prudkov M.I. ZHelchnokamennaya bolezn'. [Gallstone disease]. M. Izd. dom Vidar-M. 2000; 144S [In Russ].

5.     Ratnikov V.A., Cheremisin V.M., Shejko S.B. Sovremennye luchevye metody (ul'trazvukovoe issledovanie, rentgenovskaya komp'yuternaya i magnitno-rezonansnaya tomografiya) v diagnostike kholedokholitiaza (obzor literatury) [Modern radiation techniques (ultrasound, X-ray CT and MRI) in the diagnosis of choledocholithiasis (literature review)]. Meditsinskaya vizualizatsiya. 2002;3: 99-106 [In Russ].

6.     Popova I.E., SHarifullin FA. Primenenie magnitnorezonansnoj kholangiopankreatografii v diagnostike kholedokholitiaza. Moskva. [The use of magnetic resonance cholangiopancreatography in the diagnosis of choledocholithiasis ]. Materialy gorodskogo seminara «Aktualnie voprosy diagnostiki i lecheniya kholedokholitiaza, oslozhnennogo mekhanicheskoj zheltukhoj i kholangitom». 2009; 15-17 [In Russ].

7.     Аbdulamitov KH.K., Rogal' M.L., Moiseeva L.V. Popova I.E. SHavrina I.V. Kuprikov S.V. Rol' magnitnorezonansnoj kholangiografii v diagnostike patologii zhelchevyvodyashhikh protokov u bol'nykh v otdalennom periode posle videolaparoskopicheskoj kholetsistehktomii ["The role of magnetic resonance cholangiography in the diagnosis of biliary tract disease in patients in the late period after cholecystectomy videolaparoscopic ]. Rossijskij zhurnal Gastroehnterologii, Gepatologii, Koloproktobgii. 2008;18(5):111 [In Russ].

8.     Tham T.C., Lichtenstein D.R., Vandervoort J. et al. Role of endoscopic retrograde cholangiopancreatography for suspected choledocholithiasis in patients undergoing laparoscopic cholecystectomy. Gastrointestinal Endoscopy. 1998; 47: 50-56.

9.     Sharma S.K., Larson K.A., Adler Z. et al. Role of endoscopic retrograde cholangiopancreatography in the management of suspected choledocholithiasis. Surgical Endoscopy. 2003; 17: 868-871.