[Acute cholecystitis in patients over 70 years old]

Gallstone disease is the most common surgical indication in the elderly. Post-operative prognosis is severe in elderly with acute cholecystitis. Aim of this paper is to investigate the factors responsible for the severe prognosis and to detect how it could be improved.

One hundred fifty-seven patients, aged between 70 and 85 years (average 82 years), undergoing cholecystectomy between the years 1990 and 2000 have been studied; 65 patients (group A) had acute cholecystitis; 92 (group B) had uncomplicated gallbladder stones.

Acute cholecystitis was the first symptom of gallstone disease in 69.2%. Laparocholecystectomy was performed in 31 cases (47.6%) of group A and in 58 cases (63.7%) of group B. In those cases with acute cholecystitis the postoperative morbidity (18.4%) was higher than in group B (1.0%), (A vs B: chi(2)=15.3; p<0.001). Similarly, postoperative mortality was higher (6.1% vs 1.0%; chi(2)=3.2; p<0.05) The severe postoperative prognosis was correlated significantly to index ASA (ASA II vs IV: chi(2)=7.0; p<0.001) but not to the technique adopted for cholecystectomy (VLC vs open: (chi)2=0.01; p=n.s.). The results obtained seem to confirm that the high incidence of postoperative complications in acute cholecystitis is due to the presence of associated diseases in elderly patients accompanied by the septic state.

Early colecystectomy, in those cases with symptomatic, uncomplicated gallstone disease, might avoid severe postoperative prognosis in the elderly.