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[Biliary surgery in the aged]

G Catania1, G A Petralia, T Salanitri

  • 1Dipartimento di Chirurgia, Università degli Studi di Catania.

Annali Italiani Di Chirurgia
|January 1, 1997
PubMed
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Elderly patients with biliary issues benefit from timely interventions. Cholelithiasis and acute cholecystitis require surgery, while choledocholithiasis and severe pancreatitis are best managed endoscopically.

Area of Science:

  • Gastroenterology and Hepatology
  • Surgical Oncology
  • Geriatric Surgery

Background:

  • The elderly population presents unique challenges in managing surgical biliary diseases.
  • A significant proportion of biliary procedures are performed on elderly patients, often in emergency settings.

Purpose of the Study:

  • To analyze the outcomes of various treatments for biliary diseases in elderly patients.
  • To establish optimal treatment strategies for different biliary conditions in the geriatric population.

Main Methods:

  • Retrospective analysis of 1715 biliary surgical procedures performed between 1980 and 1995.
  • Categorization of procedures by condition (cholelithiasis, cholecystitis, choledocholithiasis, neoplasms, cholangitis, pancreatitis) and treatment modality (surgical, endoscopic, radiological).

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  • Evaluation of morbidity and mortality rates for each treatment approach in elderly patients.
  • Main Results:

    • Cholelithiasis and acute cholecystitis in the elderly are best treated with cholecystectomy, showing low mortality.
    • Endoscopic treatment for choledocholithiasis and severe acute biliary pancreatitis yielded lower morbidity and mortality compared to surgery.
    • Complex conditions like acute obstructive cholangitis and acute biliary pancreatitis demonstrated high risks, with endoscopic or radiological drainage showing better outcomes than surgery in some cases.

    Conclusions:

    • Cholecystectomy remains the gold standard for cholelithiasis and acute cholecystitis in the elderly.
    • Endoscopic procedures are preferred for choledocholithiasis and severe acute biliary pancreatitis.
    • A multidisciplinary team approach involving surgical, endoscopic, and radiological expertise is crucial for optimizing care in elderly patients with surgical biliary problems.