Colecistectomía laparoscópica en pacientes octogenarios. Estudio comparativo entre dos poblaciones en edad geriátrica

Sánchez-Beorlegui, Jesús; Soriano, Pablo; Monsalve, Eduardo; Moreno, Núria Llorens; Cabezali, Roger; Navarro, Ana

doi:10.1016/j.ciresp.2008.11.001

Cited by 4 publications

(6 citation statements)

References 26 publications

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“…Laparoscopic cholecystectomy in older patients was shown to be a safe treatment option even in case of AC [7, 11–13, 15–17], although conservative treatment can also be justified [7, 19]. The latter can initially give good results, but in our study 11 patients out of 240 on conservative treatment had to be urgently operated because of the rapid deterioration.…”

Section: Discussionmentioning

confidence: 81%

“…It is known that the comorbidities present in patients over 80 years limit the choice of therapeutic options [12, 13, 16]. Besides, these patients often have a history of previous biliary diseases and concomitant choledocholithiasis at the time of diagnosis [21], which must be taken into consideration when choosing the treatment, since, together with age and patient's physical status, it affects the outcomes [13].…”

Section: Discussionmentioning

confidence: 99%

“…Some authors propose to adapt watchful waiting in patients with symptomatic cholelithiasis who are older than 90 years and to recur to cholecystectomy only when the condition evolves into AC [17]. Laparoscopic cholecystectomy was shown to be safe in patients older than 80 years [11, 13, 17] and helps to avoid readmissions and complications related to biliary tract problems. The optimal moment for cholecystectomy is not well defined.…”

Section: Discussionmentioning

confidence: 99%

“…Cholecystectomy was categorized into early (within 48 hours after hospital admission) or delayed (after 48 hours). The complications were evaluated according to Dindo–Clavién scale [13, 22] after having initiated the prescribed treatment.…”

Section: Methodsmentioning

confidence: 99%

“…However, the optimal management of AC in patients >85 years is less clear. Some studies suggest that early laparoscopic cholecystectomy yields good results in elderly patients [14–18]; but most of these studies included patients ≥65 years [9, 13, 18–20], with only few studies focused on patients of more advanced age [12, 16, 21]. Even in those few studies, most patients were 80–85 years, with very few patients older than 85, and there was no specific analysis of the population of >85 years.…”

Section: Introductionmentioning

confidence: 99%

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Acute Cholecystitis in Very Elderly Patients: Disease Management, Outcomes, and Risk Factors for Complications

Escartín

González

Cuello

et al. 2019

Surgery Research and Practice

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Background. The aim of this study was to evaluate the characteristics, management, and outcomes of acute cholecystitis in patients ≥80 years. Methods. This was a retrospective analysis of data from a prospective single-center patient registry. Results. The study population was composed of 348 patients, which were divided into two groups: those younger (Group A) and those older (Group B) than the median age (85.4 years). Although demographic and clinical characteristics of the two groups were similar, the disease management was clearly different, with older patients undergoing cholecystectomy less frequently (n=80 46.0% in Group A vs n=39 22.4% in Group B; p<0.001). The outcomes in both groups of age were similar, with 30-day mortality of 3.7%, morbidity of 17.2%, and readmissions of 4.2% and two-year AC recurrence in nonoperated patients of 22.5%. No differences were seen between operated and no operated patients. Severe (Grade III) AC was the only independent factor significantly associated with mortality (OR 86.05 (95% CI: 11–679); p<0.001). Conclusions. In elderly patients with AC, the choice of therapeutic options was not limited by the age per se, but rather by the disease severity (grade III AC) and/or poor physical status (ASA III-IV). In case of grade I-II AC, laparoscopic cholecystectomy can be safely performed and yield good results even in very old patients. Patients with grade III AC present high risk of morbidity and mortality, and the treatment should be individualized. ASA IV patients should avoid cholecystectomy, being antibiotic treatment and cholecystectomy the best option.

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