Abstract

SANCHEZ BEORLEGUI, Jesús; LAGUNAS LOSTAO, Emilio; LAMATA HERNANDEZ, Félix  and  MONSALVE LAGUNA, Eduardo César. Treatment of acute cholecystitis in the elderly: urgent surgery versus Medical therapy and surgery delay. Rev. gastroenterol. Perú [online]. 2009, vol.29, n.4, pp.332-340. ISSN 1022-5129.

INTRODUCTION. Acute cholecystitis in elderly patients is a frequent disease characterized by a high mortality rate and serious complications. The choice between emergency surgery or conservative therapy in addition to delayed surgery is a controversial issue. PATIENTS AND METHODS. Retrospective cohort study over patients aged 70 years or older undergoing acute cholecystitis treatment between 2003 and 2009. Epidemiological, clinical, diagnostic, surgical and cost-effectiveness parameters were analysed. Statistical method: We use Chi squared test, Student´s t test and ANOVA. A level of p < 0.05 was accepted as significant. RESULTS. During the six-year period studied 173 episodes of acute cholecystitis were treated on 147 patients (52% females), with an average age of 80.6 years (maximum 101). In 103 episodes (77 patients) medical treatment was taken, 31 of them undergone elective surgery by means of 100% laparoscopic approach, 6,4% conversion rate, 9,6% morbidity in absence of mortality. In other 85 patients emergency surgery was performed, 78.5% of them through laparoscopy approach with a conversion rate of 19.7%, 53% morbidity and 3,5% mortality. Conclusions. Taking into account all variables, emergency surgery and medical treatment followed by elective cholecistectomy get similar outcomes, making better progress those who underwent early laparoscopic cholecystectomy.

Keywords : Acute Cholecystitis; Cholelithiasis; Emergency surgery; Medical treatment; Laparoscopic Cholecystectomy; Open surgery; Elderly; Surgical complications.

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