Laparoscopic Cholecystectomy versus Percutaneous Drainage for Acute Cholecystitis in Elderly

There is ongoing debate regarding the best management strategy for acute calculous cholecystitis (ACC) in the oldest old population. The present study sought to evaluate clinical outcomes following laparoscopic cholecystectomy (LC) versus percutaneous transhepatic gallbladder drainage (PTGD) in elderly individuals diagnosed with ACC.

This retrospective study included 135 elderly ACC patients (mean age >80 years) treated from January 2023 to December 2024. Of these, 68 underwent LC and 67 received PTGD. Between-group comparisons covered baseline profiles, a primary composite outcome (all-cause death or major complications at 1 year), secondary endpoints, and healthcare resource use.

The two groups were largely comparable at baseline, except that gallbladder wall thickness (median 4.0 vs 3.0 mm, P = .003) and symptom-to-admission interval (3.0 vs 2.0 days, P = .048) were slightly higher in the LC cohort. The primary composite endpoint was met by 30.9% of LC patients versus 55.2% of PTGD patients (P = .004). Major complications alone also favored LC (29.4% vs 52.2%, P = .007). One-year mortality showed no significant between-group difference (1.5% vs 3.0%, P = .618). Compared with PTGD, LC yielded markedly fewer overall infectious events (7.4% vs 40.3%, P < .001), lower reintervention requirement (7.4% vs 32.8%, P < .001), and less recurrent biliary disease (7.4% vs 47.8%, P < .001). Median hospital stay was shorter after LC (5.0 vs 10.0 days, P = .013).

For elderly ACC patients, LC offers significant advantages over PTGD in terms of major complications, reinterventions, recurrent biliary disease, and hospitalization duration. Thus, LC ought to be the favored approach for elderly individuals who are surgical candidates.