Surgical tactics for acute cholecystitis in persons 60 years of age and older

The overall mortality rate among patients operated on for acute cholecystitis has significantly decreased in recent years and ranges from 1.3% to 2.4% (GG Karavanov and FA Spektor, Ya. I. Grinberg). However, when analyzing these indicators, it turns out that among those who died after surgery, the bulk of them are people aged 60 and older. According to B.A.Petrov, the mortality rate at this age was 12.2%, according to B.A.Korolev and D.L. Pikovsky - 13.7%, according to A.I. Masumov - 25%, according to B.M. Khromov and L.P. Vinogradova - 45%. Apparently, an explanation for this should be sought in the pronounced phenomena of atherosclerosis, the frequent presence of more or less severe concomitant diseases, a decrease in the body's resistance to infection and a decrease in tolerance to surgical trauma. The latter, when it comes to cholecystectomy, remains quite significant. Apparently, each patient should carefully measure the severity of the forthcoming surgical intervention with his general condition. It is pertinent to recall that even at the 17th-18th congresses of Russian surgeons S.P. Fedorov, E.R. Hesse, P.A.Herzen and N.N.Petriv suggested resorting to cholecystosmia in seriously ill patients. In subsequent years, due to the significant activation of tactics in acute cholecystitis, the indications for cholecystostomy were sharply narrowed.