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[Biliary lithiasis in patients over 75. 100 cases operated upon (author's transl)]
Insights
Elderly patients with biliary tract calculi tolerated surgery well, with low mortality and morbidity. Early intervention is recommended for acute infections like cholecystitis and cholangitis.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Geriatric Medicine
Context:
- Biliary tract calculi (gallstones) are common in the elderly.
- Surgical management in this population requires careful consideration of comorbidities.
- The study focuses on elderly patients (≥75 years) undergoing surgery for gallstones.
Purpose:
- To evaluate the outcomes of surgical intervention for biliary tract calculi in elderly patients.
- To assess the impact of common bile duct stones and acute infection on surgical results.
- To determine optimal surgical strategies for this demographic.
Summary:
- A retrospective analysis of 100 elderly patients (≥75 years) with biliary tract calculi.
- Surgical procedures included cholecystectomy and common bile duct exploration in select cases.
- Low morbidity (11 complications) and mortality (1 death) were observed, irrespective of common bile duct stones or acute infection.
Impact:
- Surgical outcomes for biliary tract calculi in the elderly are favorable, even with comorbidities.
- The presence of common bile duct stones or acute infection did not significantly increase mortality or morbidity.
- Simple, complete surgical procedures with high-quality medical surveillance are crucial for successful outcomes in elderly patients.
Abstract:
This is a retrospective study of 100 elderly patients (36 men and 64 women aged 75 years or more) operated upon for biliary tract calculi. Thirty-one patients had one or several underlying visceral diseases and 5 had associated carcinoma of the digestive tract. Calculi of the common bile duct were present in 48 cases, and 41 patients had acute infection, including cholecystitis (14) and cholangitis (27). Surgery included cholecystectomy in every case and opening of the common bile duct in 49 cases with either choledocho-duodenal anastomosis (31 cases) or external biliary drainage (18 cases). Only one patient with gastric carcinoma died. The morbidity rate was low (11 post-operative complications) and each group of patients spent about the same time in hospital. Neither mortality nor morbidity were aggravated by the presence of calculi in the common bile duct and/or acute infection. In uncomplicated lithiasis the surgical indications mainly depend upon the severity of underlying visceral diseases. Early intervention seems desirable in most patients with acute cholecystitis or cholangitis. Surgery of the biliary tract is basically the same in elderly and in young patients, but the operation must be simple and, if possible, complete. The quality of medical surveillance and nursing has considerable influence on the results.