Modern approaches to the diagnosis and treatment of choledocholithiasis in elderly and senile patients

Currently, the problem of gallstone disease is becoming not only medically, but also socially significant. This trend is determined by the widespread occurrence of this pathology, as well as the large number of complications associated with it. One of these complications is choledocholithiasis, which occurs with a frequency of 10-15%. Elderly and senile patients face this complication more often, ranging from 35 to 68% of cases. In 15-20% of cases, choledocholithiasis is noted to be asymptomatic; therefore, it becomes necessary to search for a new treatment and diagnostic algorithm for elderly patients with complicated forms. In this study this very search is of much relevance and great practical significance. Nowadays four stages can be distinguished in the course of gallstone disease. It is also possible to identify clinical parameters that, with varying degrees of evidence, can indicate that a patient is ill. According to the selected parameters, patients, in the vast majority, can be divided into groups with a low (10%), medium (10-50%) and high (>50%) probability of choledocholithiasis. The modern diagnostic technique includes several stages, among them are collection of anamnesis, objective examination and laboratory research. The final stage is an instrumental research method that can be preoperative or intraoperative. Basing on the clinical parameters (very significant, highly significant and moderate) and the following determination of the risk group, foreign authors recommended an algorithm for diagnosis and treatment. Most authors tend to believe that traditional surgical interventions performed in elderly and senile patients at the height of jaundice can be associated with severe intra- and postoperative complications and high mortality. Classical laparotomy is considered a reserve operation and is used when other methods are ineffective. The studies carried out have proved that a «gold standard» applying 2-stage tactics is appearing at the moment. Nevertheless, choosing a rational method of treatment for this group of patients remains an urgent problem.