Management of gallstone disease in the elderly

Abstract

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.

Expectant treatment or cholecystectomy after endoscopic retrograde cholangiopancreatography for choledocholithiasis in patients over 80 years old?

“…This indicates therefore that patients over 80 years can be managed expectantly after ERCP for bile duct stones. This conclusion was also reached in a prospective study by Arthur et al [1]. They concluded that ERCP for the management of choledocholithiasis in patients over the age of 80 years might be the only intervention that is necessary in order to achieve an asymptomatic state.…”

Routine laparoscopic cholecystectomy after endoscopic sphincterotomy for choledocholithiasis in octogenarians: is it worth the risk?

“…The mean mortality rate for LC, as reported by national surveys exceeding 10,000 patients [18,35], is almost 10 times higher for octogenarians than for the general population (1.8% vs 0.2%). These data are confirmed by a review of the English language literature (Table 5) [1,2,4,8,9,15,22,30,31,33], which reports an overall mortality rate of 2% for LC in the very elderly, approaching 10% in some series [15,30,33]. In view of this consideration, a regular follow-up evaluation of very elderly patients after ES has been suggested [13,23], with cholecystectomy performed only when strictly needed.…”

A laparoszkópia szerepe a 80 évesnél idősebb betegek epekövességének megoldásában

“…Pedig Kuwabara 2552, 60 év feletti betegnél -akiknek 15%-a 80 év feletti volt -elvégzett elektív és akut cholecystectomia adatait feldolgozva egyértelműen igazolta, hogy a 48 órán túl elvégzett cholecystectomiák esetében szignifikánsan hosszabb volt a műtéti idő, valamint a posztoperatív kórházi tartózkodási napok száma [12]. Be kell vallanunk, hogy idős betegek esetében olykor mi, sebészek is könnyebben döntünk a konzervatív kezelés mellett, s a betegek 30%-a még intervenciós terá-piában (ERCP, EST) sem részesül [13,14]. Pedig a korai cholecystectomia előnyös az időskorúak enyhe biliaris pancreatitisének kezelésében is [15].…”