T he latter half of the 20th century saw an increase in the incidence of gallstone disease (GSD) in Britain. This was partly due to the increasing age of the population. It is estimated that up to 28% and 42% of men and women, respectively, aged 80-89 years have gallstones. Of these, 30% are symptomatic, and are seen by surgeons around Conclusions: This study suggests that recurrent GSD in elderly patients managed non-operatively may have fatal outcome. Elective cholecystectomy has acceptable morbidity and mortality in this age group and there is often ample opportunity to avoid emergency surgery, but a prospective randomised study is required to improve clinical algorithms.