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Acute Cholecystitis

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Emergency laparoscopic surgery in the elderly and frail patient

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Abstract

Acute cholecystitis is more common in aged than younger people. Old age and frailty have crucial implications in its management: the risk of severe consequences is increased for the higher prevalence of co-morbidities, more frequent complications, and increased number of severe forms. Age-related changes also influence the established diagnostic parameters and may cause misdiagnosis and delays. We examine the literature’s best evidence about the emergency treatment of acute cholecystitis in the elderly: its risks, the best treatment available in this population group, the role of laparoscopy, the best timing for surgery. We also analyze the role of alternatives to surgery and the possibility to tailor the treatment to the clinical conditions of the frailer and older patients.

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Notes

  1. 1.

    After adjustment for time to surgery, gender, race, number of biliary diagnoses, type of procedure, admission urgency, comorbidities, year, hospital size, and hospital teaching status.

  2. 2.

    The 30-day, 1-year, and 2-year cumulative mortality rates were 2, 9, and 15.2% in surgical group; versus 5, 19.4, and 29.3% in the non-surgical group (p < 0.0001).

  3. 3.

    Hazard Ratio = 1.56, 95% CI 1.47–1.65

  4. 4.

    In 37.7% the readmission was due to a new episode of cholecystitis; they also reported 2.3% cholangitis, 6.8% obstructive jaundice, 6.5% biliary colic, and 1.9% pancreatitis.

  5. 5.

    A detailed description of their findings is outside the scope of this work; a more complete discussion about early and late surgical treatment in acute cholecystitis can be found in some of the mentioned guidelines [48, 49].

  6. 6.

    The Tokyo guidelines classify as severe any cholecystitis with organ/system dysfunction (cardiovascular, respiratory, renal, hematologic, hepatic, neurological), and moderate any cholecystitis with elevated WBC count (>18,000/mm3), palpable tender mass, duration of complaints >72 h, or marked local inflammation [15].

  7. 7.

    Two patients in each group died during the follow-up for unrelated causes (cancer or intestinal ischemia) and one (in the drainage group) for unknown cause. The remaining three deaths in the drainage group were due to cholecystitis related sepsis.

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Authors and Affiliations

  1. Division of Surgery, ASL Viterbo, Ospedale San Giovanni Decollato Andosilla, Civita Castellana, Italy

    Fabio Cesare Campanile, Monica De Angelis, Elisabetta Santucci & Ilaria Vecchioni

Authors
  1. Fabio Cesare Campanile
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  2. Monica De Angelis
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  3. Elisabetta Santucci
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  4. Ilaria Vecchioni
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Editor information

Editors and Affiliations

  1. Department of General Surgery, ULSS2 Trevigiana del veneto, Vittorio Veneto (TV), Italy

    Ferdinando Agresta

  2. Policlinico Universitario Duilio Casula, AOU Cagliari, Department of Emergency Surgery, Monserrato, Italy

    Mauro Podda

  3. General Surgery, Ospedale San Giovanni Decollato - Andosilla, Civita Castellana, Viterbo, Italy

    Fabio Cesare Campanile

  4. Department of Emergency Surgery, AOU Careggi, Firenze, Italy

    Carlo Bergamini

  5. UO di chirurgia Generale e Toracica, AOU Ferrara, Ferrara, Italy

    Gabriele Anania

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Campanile, F.C., De Angelis, M., Santucci, E., Vecchioni, I. (2021). Acute Cholecystitis. In: Agresta, F., Podda, M., Campanile, F.C., Bergamini, C., Anania, G. (eds) Emergency laparoscopic surgery in the elderly and frail patient. Springer, Cham. https://doi.org/10.1007/978-3-030-79990-8_7

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  • DOI: https://doi.org/10.1007/978-3-030-79990-8_7

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