[Therapeutic tactics in acute obstruction of the terminal part of the common bile duct]. / Lechebnaia taktika pri ostroi blokade terminal'nogo otdela kholedokha.

The authors had 158 patients with acute block of the terminal part of the choledochus under observation. According to the clinical course, a biliary, pancreatic, and mixed forms were distinguished. The emergency diagnostic program was made up of ultrasonic examination, esophagogastroduodenoscopy, ERCP, and laparoscopy. The cause of the block of the terminal choledochus was choledocholithiasis in 104 patients, papillitis and microcholedocholithiasis in 36, and ++choledocholithiasis and stenosis of the major duodenal papilla in 18 patients. Acute block of the major duodenal papilla was found in 76 and acute block of the intramural part of the choledochus in 76 patients. The mixed form prevailed in the first and the biliary form of hypertension in the second. Operations (cholecystectomy, choledocholithotomy with external or internal drainage of the choledochus) were performed on 42 patients, the postoperative fatality rate was 9.7%. Emergency EPST and extraction of concrements was undertaken in 116 patients. Increase in the clinical picture of acute cholecystitis and destructive pancreatitis after EPST called for operative interventions on 21 patients. The lethality rate after EPST performed for acute block of the terminal choledochus was 6.1%.

[Decompression of the gallbladder in acute cholecystitis in middle-aged and elderly patients]. / Dekompressiia zhelchnogo puzyria pri ostrom kholetsistite u bol'nykh pozhilogo i starcheskogo vozrasta.

The authors showed that operations for decompression of the gallbladder may improve the results of surgical treatment of acute cholecystitis in elderly and senile patients at a high anesthesiological risk. Decompression operations reduced postoperative fatality among patients of the most "threatened" group to 3.5%.

[Laparoscopic microcholecystostomy in the treatment of acute cholecystitis]. / Laparoskopicheskaia mikrokholetsistostomiia v lechenii ostrogo kholetsistita.

Laparoscopic microcholecystostomy is recommended by the authors for nonarrested attack of acute cholecystitis in patients with high operative-anesthesiological risk as the first step of treatment. Delayed operations are performed after arrest of the inflammatory process in the gallbladder and correction of the coexistent pathology. The use of laparoscopic microcholecystostomy considerably decreased lethality in most dangerous contingent of patients.

[Surgical treatment of acute cholecystitis complicated by peritonitis in middle-aged and elderly patients]. / Khirurgicheskoe lechenie ostrogo kholetsistita, oslozhnennogo peritonitom, u bol'nykh pozhilogo i starcheskogo vozrasta.

Peritonitis is among the severe complications of acute cholocystitis; the authors encountered its generalized forms in 10.9% of the patients who were operated on as being critically ill. Gangrenous or perforating cholecystitis was the most frequent cause of peritonitis. The high postoperative death rate (22.4%) caused among elderly and old-aged patients by generalized peritonitis and the necessity of an emergency operation requires intensive preoperative management and complex postoperative treatment with the application of modern detoxification methods in an intensity care department. In view of the high operative-anesthetic risk in patients of the old-age groups, the authors undertook sparing operations for decompression of the gallbladder in generalized peritonitis with the subsequent performance of a radical sanitizing operation in a postponed or planned order. This allowed the postoperative death rate to be reduced to 7.7% in the recent years.