INTRODUCTION: Acute cholecystitis in elderly patients is a frequent disease characterized by a high mortality rate and serious complications. The choice between emergency surgery or conservative therapy in addition to delayed surgery is a controversial issue. PATIENTS AND METHODS: Retrospective cohort study over patients aged 70 years or older undergoing acute cholecystitis treatment between 2003 and 2009. Epidemiological, clinical,diagnostic, surgical and cost-effectiveness parameters were analysed. STATISTICAL METHOD: We use Chi squared test, Student's t test and ANOVA. A level of p < 0.05 was accepted as significant. RESULTS: During the six-year period studied 173 episodes of acute cholecystitis were treated on 147 patients (52% females), with an average age of 80.6 years (maximum 101). In 103 episodes (77 patients) medical treatment was taken, 31 of them undergone elective surgery by means of 100% laparoscopic approach, 6,4% conversion rate, 9,6% morbidity in absence of mortality. In other 85 patients emergency surgery was performed, 78.5% of them through laparoscopy approach with a conversion rate of 19.7%, 53% morbidity and 3,5% mortality. CONCLUSIONS: Taking into account all variables, emergency surgery and medical treatment followed by elective cholecistectomy get similar outcomes, making better progress those who underwent early laparoscopic cholecystectomy.
INTRODUCTION:Acute cholecystitis in elderly patients is a frequent disease characterized by a high mortality rate and serious complications. The choice between emergency surgery or conservative therapy in addition to delayed surgery is a controversial issue. PATIENTS AND METHODS: Retrospective cohort study over patients aged 70 years or older undergoing acute cholecystitis treatment between 2003 and 2009. Epidemiological, clinical,diagnostic, surgical and cost-effectiveness parameters were analysed. STATISTICAL METHOD: We use Chi squared test, Student's t test and ANOVA. A level of p < 0.05 was accepted as significant. RESULTS: During the six-year period studied 173 episodes of acute cholecystitis were treated on 147 patients (52% females), with an average age of 80.6 years (maximum 101). In 103 episodes (77 patients) medical treatment was taken, 31 of them undergone elective surgery by means of 100% laparoscopic approach, 6,4% conversion rate, 9,6% morbidity in absence of mortality. In other 85 patients emergency surgery was performed, 78.5% of them through laparoscopy approach with a conversion rate of 19.7%, 53% morbidity and 3,5% mortality. CONCLUSIONS: Taking into account all variables, emergency surgery and medical treatment followed by elective cholecistectomy get similar outcomes, making better progress those who underwent early laparoscopic cholecystectomy.
Authors: L Ansaloni; M Pisano; F Coccolini; A B Peitzmann; A Fingerhut; F Catena; F Agresta; A Allegri; I Bailey; Z J Balogh; C Bendinelli; W Biffl; L Bonavina; G Borzellino; F Brunetti; C C Burlew; G Camapanelli; F C Campanile; M Ceresoli; O Chiara; I Civil; R Coimbra; M De Moya; S Di Saverio; G P Fraga; S Gupta; J Kashuk; M D Kelly; V Koka; H Jeekel; R Latifi; A Leppaniemi; R V Maier; I Marzi; F Moore; D Piazzalunga; B Sakakushev; M Sartelli; T Scalea; P F Stahel; K Taviloglu; G Tugnoli; S Uraneus; G C Velmahos; I Wani; D G Weber; P Viale; M Sugrue; R Ivatury; Y Kluger; K S Gurusamy; E E Moore Journal: World J Emerg Surg Date: 2016-06-14 Impact factor: 5.469